Provider Demographics
NPI:1669667358
Name:OBRIEN, MINDY COSTA (PTA)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:COSTA
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DERRY RD
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5605
Mailing Address - Country:US
Mailing Address - Phone:978-258-6788
Mailing Address - Fax:
Practice Address - Street 1:501 MAHAR HWY
Practice Address - Street 2:NORTON AND ASSOCIATES
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-843-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7903225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant