Provider Demographics
NPI:1972654382
Name:O'BRIEN, DENISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CHAFFEE LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3467
Mailing Address - Country:US
Mailing Address - Phone:815-462-9093
Mailing Address - Fax:815-462-9093
Practice Address - Street 1:805 CHAFFEE LN
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3467
Practice Address - Country:US
Practice Address - Phone:708-305-2384
Practice Address - Fax:815-462-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009932330OtherBLUE CROSS BLUE SHIELD
ILDO13461099POtherEARLY INTERVENTION IDHS