Provider Demographics
NPI:1992705909
Name:OBRIEN, ANNE E (PT)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:E
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 RAMSEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5808
Mailing Address - Country:US
Mailing Address - Phone:541-476-1919
Mailing Address - Fax:541-476-1920
Practice Address - Street 1:497 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5681
Practice Address - Country:US
Practice Address - Phone:541-476-1919
Practice Address - Fax:541-476-1920
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043542Medicaid
ORJ284207OtherPACIFIC SOURCE INSURANCE
ORP00043501OtherMEDICARE RAILROAD
OR043542Medicaid