Provider Demographics
NPI:1609123405
Name:O'BRIEN, JOHN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
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 1:20981 E SMOKY HILL RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5188
Mailing Address - Country:US
Mailing Address - Phone:720-870-8900
Mailing Address - Fax:720-870-8901
Practice Address - Street 1:20981 E SMOKY HILL RD
Practice Address - Street 2:UNIT A
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5188
Practice Address - Country:US
Practice Address - Phone:720-870-8900
Practice Address - Fax:720-870-8901
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist