Provider Demographics
NPI:1295042323
Name:WRIGHT, BRYAN BURDETT (PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:BURDETT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 TARA CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-1638
Mailing Address - Country:US
Mailing Address - Phone:937-238-8643
Mailing Address - Fax:937-238-8864
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-870-5342
Practice Address - Fax:513-870-5343
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist