Provider Demographics
NPI:1295802817
Name:O'BRIEN, ALICIA DANIELLE
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:DANIELLE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RIVERSIDE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4438
Mailing Address - Country:US
Mailing Address - Phone:203-588-0569
Mailing Address - Fax:
Practice Address - Street 1:672 POST RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5008
Practice Address - Country:US
Practice Address - Phone:914-722-2400
Practice Address - Fax:914-722-2406
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028712-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist