Provider Demographics
NPI:1275699035
Name:WRIGHT, MARK G (MSPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6856 CASUAL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3117
Mailing Address - Country:US
Mailing Address - Phone:408-997-0967
Mailing Address - Fax:
Practice Address - Street 1:700 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5439
Practice Address - Country:US
Practice Address - Phone:408-945-5802
Practice Address - Fax:408-945-6154
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist