Provider Demographics
NPI:1558807503
Name:O'BRIEN, CHRISTA ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:ELIZABETH
Other - Last Name:LAUSTSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4840 HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6401 AMERICA BLVD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2357
Practice Address - Country:US
Practice Address - Phone:301-276-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist