Provider Demographics
NPI:1114326683
Name:WRIGHT, DALE (PTA)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 IONE LN
Mailing Address - Street 2:
Mailing Address - City:BOSLER
Mailing Address - State:WY
Mailing Address - Zip Code:82051-9605
Mailing Address - Country:US
Mailing Address - Phone:307-721-5697
Mailing Address - Fax:
Practice Address - Street 1:8540 SCARBOROUGH DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7513
Practice Address - Country:US
Practice Address - Phone:719-314-0151
Practice Address - Fax:719-630-8099
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0832225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant