Provider Demographics
NPI:1396358321
Name:O'BRYAN, DEIRDRE (PT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:O'BRYAN
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 1:179 HERNANDEZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1011
Mailing Address - Country:US
Mailing Address - Phone:415-806-2503
Mailing Address - Fax:
Practice Address - Street 1:930 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-1628
Practice Address - Country:US
Practice Address - Phone:415-974-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist