Provider Demographics
NPI:1821242637
Name:WRIGHT, KATHLEEN CANNON (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CANNON
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WALTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6960
Mailing Address - Country:US
Mailing Address - Phone:518-441-1599
Mailing Address - Fax:518-279-0968
Practice Address - Street 1:15 WALTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6960
Practice Address - Country:US
Practice Address - Phone:518-441-1599
Practice Address - Fax:518-279-0968
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011162-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics