Provider Demographics
NPI:1932350824
Name:WRIGHT, GEORGE EDWARD (LPT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:690 N 9TH AVE
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0593
Mailing Address - Country:US
Mailing Address - Phone:406-346-7617
Mailing Address - Fax:
Practice Address - Street 1:100 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0070
Practice Address - Country:US
Practice Address - Phone:406-477-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000005924Medicare PIN