Provider Demographics
NPI:1538475389
Name:O'BRIEN, ALEXANDRA ANN (PT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANN
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 1:612 E PENN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3712
Mailing Address - Country:US
Mailing Address - Phone:516-330-6653
Mailing Address - Fax:
Practice Address - Street 1:612 E PENN ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3712
Practice Address - Country:US
Practice Address - Phone:516-330-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021808-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist