Provider Demographics
NPI:1861762692
Name:WRIGHT, PHILIP (CMT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8974
Mailing Address - Country:US
Mailing Address - Phone:530-575-1506
Mailing Address - Fax:
Practice Address - Street 1:152 MILL ST
Practice Address - Street 2:SUITE G
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4771
Practice Address - Country:US
Practice Address - Phone:530-575-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist