Provider Demographics
NPI:1790167807
Name:WRIGHT, OBRIAN (BBA, PTA)
Entity Type:Individual
Prefix:
First Name:OBRIAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:BBA, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7963
Mailing Address - Country:US
Mailing Address - Phone:203-797-9300
Mailing Address - Fax:
Practice Address - Street 1:33 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7963
Practice Address - Country:US
Practice Address - Phone:203-797-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001550225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant