Provider Demographics
NPI:1720455892
Name:O'BRIEN, MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:N CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-2159
Mailing Address - Fax:
Practice Address - Street 1:1985 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2418
Practice Address - Country:US
Practice Address - Phone:412-672-2352
Practice Address - Fax:412-672-2657
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024734225100000X
VA2305209680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist