Provider Demographics
NPI:1780600015
Name:O'BRIEN, PATRICIA KATHRYN (PT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KATHRYN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-1475
Mailing Address - Country:US
Mailing Address - Phone:209-869-0585
Mailing Address - Fax:209-869-0586
Practice Address - Street 1:3200 SIERRA ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2439
Practice Address - Country:US
Practice Address - Phone:209-869-0585
Practice Address - Fax:209-869-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2561935Medicaid