MEDICARE: WRAIGHT WELIVER

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	225200000X	Physical Therapy Assistant	18326	FL

General Provider Information

NPI Number	:	1730629858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WRAIGHT WELIVER

Provider Business Mailing Address
First Line	:	1322 13TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 13TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6659
Country	:	US
Telephone Number	:	561-386-4403
Fax Number	:

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

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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