Provider Demographics
NPI:1194722967
Name:WRIGHT, GREGORY D (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-577-2002
Mailing Address - Fax:203-577-2006
Practice Address - Street 1:1579 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-577-2002
Practice Address - Fax:203-577-2006
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26204225100000X
CT003180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003180CT22OtherANTHEM BLUE CROSS SHIELD
CT004122389Medicaid
CT6033310002Medicare NSC
CT650008918Medicare PIN
CT080003180CT22OtherANTHEM BLUE CROSS SHIELD