Provider Demographics
NPI:1346241577
Name:OBRIEN, GAIL (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
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 1:309 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1858
Mailing Address - Country:US
Mailing Address - Phone:802-447-7878
Mailing Address - Fax:802-447-7878
Practice Address - Street 1:309 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1858
Practice Address - Country:US
Practice Address - Phone:802-447-7878
Practice Address - Fax:802-447-7878
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0001060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2106Medicaid
VTVN210601Medicare PIN
VTOVN2106Medicaid