Provider Demographics
NPI:1508917410
Name:O'BRIEN, RANDY JOSEPH (DPT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JOSEPH
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 CENTRE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1916
Mailing Address - Country:US
Mailing Address - Phone:703-818-8804
Mailing Address - Fax:703-818-2498
Practice Address - Street 1:7521 VIRGINIA OAKS DR
Practice Address - Street 2:SUITE 240
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:703-753-7600
Practice Address - Fax:703-753-8070
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01773R01Medicare PIN
VA00W348R01Medicare PIN