Provider Demographics
NPI:1558734517
Name:O'BRIEN, LISA MARIE (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-235-0200
Mailing Address - Fax:843-235-0242
Practice Address - Street 1:4731 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5090
Practice Address - Country:US
Practice Address - Phone:843-314-3224
Practice Address - Fax:843-314-3596
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ52715C630OtherMEDICARE PTAN
SCQ52715E293OtherMEDICARE PTAN
SCQ527159403OtherMEDICARE PTAN
SCQ52715A382OtherMEDICARE PTAN
SCQ52715F404OtherMEDICARE PTAN
SCQ527157906OtherMEDICARE PTAN