Provider Demographics
NPI:1073370763
Name:WRIGHT, BRENT MILES
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:MILES
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W 2000 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3303
Mailing Address - Country:US
Mailing Address - Phone:385-230-5313
Mailing Address - Fax:
Practice Address - Street 1:706 N WHITE HORSE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1350
Practice Address - Country:US
Practice Address - Phone:385-230-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach