Provider Demographics
NPI:1750492377
Name:O'CONNELL, BRIAN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:O'CONNELL
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 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:401 S LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2436
Practice Address - Country:US
Practice Address - Phone:570-874-3530
Practice Address - Fax:570-874-3283
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1750492377OtherORTHONET
PA1019541330001Medicaid
PA1878706OtherHIGHMARK BLUE SHIELD
PA232918467OtherAETNA
PA50095047OtherCAPITAL BLUE CROSS
PA232918467OtherAETNA