Provider Demographics
NPI:1891197430
Name:O'BRIEN, AMY (MPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CORAZZARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:N74W16173 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0730
Mailing Address - Country:US
Mailing Address - Phone:262-565-3730
Mailing Address - Fax:
Practice Address - Street 1:7903 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1903
Practice Address - Country:US
Practice Address - Phone:414-963-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10023-0242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic