Provider Demographics
NPI:1104936038
Name:O'BRIEN, ERIC J (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:M
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:PO BOX 272
Mailing Address - Street 2:44 N BROAD ST
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0272
Mailing Address - Country:US
Mailing Address - Phone:888-648-4372
Mailing Address - Fax:888-648-4372
Practice Address - Street 1:44 N BROAD STEET
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406
Practice Address - Country:US
Practice Address - Phone:888-648-4372
Practice Address - Fax:888-648-4372
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH07705OtherLICENSE