Provider Demographics
NPI:1003901844
Name:WRIGHT, LAUREN A (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 79TH AVE
Mailing Address - Street 2:APT 227
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3855
Mailing Address - Country:US
Mailing Address - Phone:917-797-7421
Mailing Address - Fax:
Practice Address - Street 1:17660 UNION TPKE
Practice Address - Street 2:SUITE 195
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1531
Practice Address - Country:US
Practice Address - Phone:718-820-9300
Practice Address - Fax:718-820-9382
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05915IMedicare ID - Type Unspecified