Basic Information
| Provider Information | |||||||||
| NPI: | 1821346594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1848 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949481848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158979195 | ||||||||
| FaxNumber: | 4158970346 | ||||||||
| Practice Location | |||||||||
| Address1: | 246 FIRST ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941052636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154952225 | ||||||||
| FaxNumber: | 4154952228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 38018 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.