Provider Demographics
NPI:1962004432
Name:WRIGHT, LAURA ELIZABETH (ATC, MBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ATC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 TOWNESHIP BLVD APT 4107
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3938
Mailing Address - Country:US
Mailing Address - Phone:601-754-3641
Mailing Address - Fax:
Practice Address - Street 1:2955 TOWNESHIP BLVD APT 4107
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3938
Practice Address - Country:US
Practice Address - Phone:601-754-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer