Provider Demographics
NPI:1841899788
Name:NEURO DRIVE PT, PLLC
Entity type:Organization
Organization Name:NEURO DRIVE PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:716-713-5133
Mailing Address - Street 1:2300 W WABANSIA AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5355
Mailing Address - Country:US
Mailing Address - Phone:716-713-5133
Mailing Address - Fax:
Practice Address - Street 1:2300 W WABANSIA AVE APT 107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5355
Practice Address - Country:US
Practice Address - Phone:716-713-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service