Provider Demographics
NPI:1770995227
Name:WRIGHT, BRIAN (ATC, VATL)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BUFFER CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4504
Mailing Address - Country:US
Mailing Address - Phone:757-418-2095
Mailing Address - Fax:
Practice Address - Street 1:2425 SHOREHAVEN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1749
Practice Address - Country:US
Practice Address - Phone:757-648-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260016212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer