Provider Demographics
NPI:1083924302
Name:WRIGHT, GREGORY LEE (LAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 TEABERRY LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3177
Mailing Address - Country:US
Mailing Address - Phone:814-234-4373
Mailing Address - Fax:
Practice Address - Street 1:119 S FRASER ST
Practice Address - Street 2:SUITE C
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3886
Practice Address - Country:US
Practice Address - Phone:814-470-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist