MEDICARE: ELIZABETH DEEANN WRIGHT RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	979	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114938024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DEEANN WRIGHT RPT

Provider Business Mailing Address
First Line	:	402 PONCE DELEON DR
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-7241
Country	:	US
Telephone Number	:	864-231-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 ANDERSON RD
Second Line	:	SUITE C
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7651
Country	:	US
Telephone Number	:	864-295-9890
Fax Number	:	864-295-9894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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