Provider Demographics
NPI:1225081383
Name:WRIGHT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WRIGHT PHYSICAL THERAPY
Other - Org Name:WRIGHT PHYSICAL THERPAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-570-0510
Mailing Address - Street 1:5962 LA PLACE CT
Mailing Address - Street 2:STE 170
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8807
Mailing Address - Country:US
Mailing Address - Phone:800-092-9477
Mailing Address - Fax:760-931-8370
Practice Address - Street 1:2115 MONTIEL RD
Practice Address - Street 2:#103
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3587
Practice Address - Country:US
Practice Address - Phone:760-738-8190
Practice Address - Fax:760-738-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 9924225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1074192OtherFIRST HEALTH
CAOOPT99240OtherBLUE SHIELD
1074192OtherFIRST HEALTH