Provider Demographics
NPI:1912289257
Name:PYATAK-WRIGHT, ELAINE THERESE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:THERESE
Last Name:PYATAK-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 1:3713 BLACK BRANT DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1061
Mailing Address - Country:US
Mailing Address - Phone:315-622-3007
Mailing Address - Fax:
Practice Address - Street 1:195 BLACKBERRY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3047
Practice Address - Country:US
Practice Address - Phone:315-622-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist