Basic Information
| Provider Information | |||||||||
| NPI: | 1801043963 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREGORY D WRIGHT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SCORE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1579 STRAITS TPKE | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035772002 | ||||||||
| FaxNumber: | 2035772060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1579 STRAITS TPKE | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035772002 | ||||||||
| FaxNumber: | 2035772060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2035772002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 003180 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.