Provider Demographics
NPI:1194174565
Name:WRIGHT, WILLIAM OLIVER IV (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:OLIVER
Last Name:WRIGHT
Suffix:IV
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:14641 THATCHER LN
Practice Address - Street 2:SUITE 17
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1577
Practice Address - Country:US
Practice Address - Phone:317-819-6080
Practice Address - Fax:317-815-5933
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012206A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist