Provider Demographics
NPI:1851357552
Name:WRIGHT, RICHARD THOMAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S RAYNOR AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-2026
Mailing Address - Country:US
Mailing Address - Phone:312-505-8153
Mailing Address - Fax:630-972-1541
Practice Address - Street 1:218 N BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2386
Practice Address - Country:US
Practice Address - Phone:630-972-1541
Practice Address - Fax:630-972-1571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer