=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285961938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK A WRIGHT PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2009
-----------------------------------------------------
Last Update Date | 12/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6955 OAKLAND MILLS RD STE E
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-5849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-979-7171
-----------------------------------------------------
Fax | 667-200-5908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6955 OAKLAND MILLS RD STE E
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-5849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-979-7171
-----------------------------------------------------
Fax | 667-200-5908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 18186
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------