Healthcare Provider Details

I. General information

NPI: 1477981637
Provider Name (Legal Business Name): MILISSA MARIE WRIGHT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MURPHY HWY STE E
BLAIRSVILLE GA
30512-3170
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-238-7217
  • Fax: 423-954-7408
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: