MEDICARE: DR. STUART WRIGHT ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1750867750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART WRIGHT ATC

Provider Business Mailing Address
First Line	:	1000 PALISADES CIR APT 303
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-3674
Country	:	US
Telephone Number	:	202-768-6706
Fax Number	:

Provider Business Practice Location Address
First Line	:	10616 METROMONT PKWY STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7657
Country	:	US
Telephone Number	:	704-212-2400
Fax Number	:

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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