Basic Information
| Provider Information | |||||||||
| NPI: | 1023030343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 PERRY PKWY | ||||||||
| Address2: | APT G-4 | ||||||||
| City: | PERRY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310699262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789888852 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 S 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | MC RAE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310551550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789888852 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | GA1039 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.