Healthcare Provider Details

I. General information

NPI: 1285961938
Provider Name (Legal Business Name): MARK A WRIGHT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 OAKLAND MILLS RD STE E
COLUMBIA MD
21045-5849
US

IV. Provider business mailing address

6955 OAKLAND MILLS RD STE E
COLUMBIA MD
21045-5849
US

V. Phone/Fax

Practice location:
  • Phone: 443-979-7171
  • Fax: 667-200-5908
Mailing address:
  • Phone: 443-979-7171
  • Fax: 667-200-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: