Provider Demographics
NPI:1366488595
Name:O'BRIEN, MOMOKO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MOMOKO
Middle Name:
Last Name:O'BRIEN
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 1:275 S ASPEN ST
Mailing Address - Street 2:STOP 89
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9562
Mailing Address - Country:US
Mailing Address - Phone:720-847-6878
Mailing Address - Fax:720-847-6436
Practice Address - Street 1:275 S ASPEN ST
Practice Address - Street 2:STOP 89
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9562
Practice Address - Country:US
Practice Address - Phone:720-847-6485
Practice Address - Fax:720-847-6436
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist