Provider Demographics
NPI:1659094332
Name:O'BRIEN, KATHRYN PATRICIA (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PATRICIA
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72A PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-5461
Mailing Address - Country:US
Mailing Address - Phone:973-903-1518
Mailing Address - Fax:
Practice Address - Street 1:2120 MOTTMAN RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7823
Practice Address - Country:US
Practice Address - Phone:360-357-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29161225100000X
WAPT61679920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist