Healthcare Provider Details

I. General information

NPI: 1942697859
Provider Name (Legal Business Name): RALPH K WRIGHT CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 HIGHWAY A1A SUITE 203
INDIAN HARBOUR BEACH FL
32937-3566
US

IV. Provider business mailing address

137 MARTESIA WAY
INDIAN HARBOUR BEACH FL
32937-3571
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-8989
  • Fax:
Mailing address:
  • Phone: 321-773-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License NumberTT2205
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License NumberTT2205
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License NumberTT2205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: