Provider Demographics
NPI:1841365590
Name:OBRIAN, PAUL DENNIS (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DENNIS
Last Name:OBRIAN
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 1:11651 W 64TH AVE
Mailing Address - Street 2:UNIT A 5
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4323
Mailing Address - Country:US
Mailing Address - Phone:303-421-2210
Mailing Address - Fax:303-421-2473
Practice Address - Street 1:11651 W 64TH AVE
Practice Address - Street 2:UNIT A 5
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4323
Practice Address - Country:US
Practice Address - Phone:303-421-2210
Practice Address - Fax:303-421-2473
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96884347Medicaid
COCP0313Medicare PIN