Basic Information
| Provider Information | |||||||||
| NPI: | 1366611741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 SCHERM RD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706636050 | ||||||||
| FaxNumber: | 2706636051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 SCHERM RD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706636050 | ||||||||
| FaxNumber: | 2706636051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2008 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 002059 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000000553290 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 5030207 | 01 | KY | MEDICARE | OTHER |