Active NPI
Mary Ellen O'Brien, PT
- Physical Therapist
- Colchester, VT
National Provider Identifier
1285794230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 040-0003418
- Practice address
- 790 College Pkwy
Fanny Allen Rehab
Colchester, VT 05446-3007 - Phone
- (802) 847-6656
- NPI assigned
- Dec 11, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 040-0003418 | VT | Primary |
Addresses
Primary practice location
790 College Pkwy
Fanny Allen Rehab
Colchester, VT 05446-3007
Mailing address
206 Woodbine by the LK
Unit 1
Colchester, VT 05446-7858
Phone (802) 864-4929
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040-0003418 | VT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285794230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 WOODBINE BY THE LK",
"address_2": "UNIT 1",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054467858",
"telephone_number": "802-864-4929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 COLLEGE PKWY",
"address_2": "FANNY ALLEN REHAB",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054463007",
"telephone_number": "802-847-6656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'BRIEN",
"first_name": "MARY",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VT",
"license": "040-0003418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colchester, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.