Provider Demographics
NPI:1598011959
Name:WRIGHT, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:PA
Mailing Address - Zip Code:17366-8477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 MILLER LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:PA
Practice Address - Zip Code:17366-8477
Practice Address - Country:US
Practice Address - Phone:410-703-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2790172M00000X
PATE009282172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist