Provider Demographics
NPI:1033392105
Name:O'BRYAN, RICK A II (PT)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:A
Last Name:O'BRYAN
Suffix:II
Gender:M
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:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2530
Mailing Address - Country:US
Mailing Address - Phone:606-789-7201
Mailing Address - Fax:606-789-7270
Practice Address - Street 1:515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1391
Practice Address - Country:US
Practice Address - Phone:606-789-7201
Practice Address - Fax:606-789-7270
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100353940Medicaid