MEDICARE: DALE WRIGHT

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	225700000X	Massage Therapist	MT.0013158	CO

General Provider Information

NPI Number	:	1184263063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE WRIGHT

Provider Business Mailing Address
First Line	:	2290 S CORONA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4518
Country	:	US
Telephone Number	:	303-815-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 S CORONA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4518
Country	:	US
Telephone Number	:	303-815-8390
Fax Number	:

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

Provider Enumeration Date	:	12/25/2019
Last Update Date	:	12/25/2019

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Directions to “ DALE WRIGHT ” Practice Location

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