Provider Demographics
NPI:1487729950
Name:WRIGHT, MICHAEL W (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 DEER RUN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-4082
Mailing Address - Country:US
Mailing Address - Phone:712-253-0990
Mailing Address - Fax:712-255-9490
Practice Address - Street 1:2800 PIERCE ST STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3707
Practice Address - Country:US
Practice Address - Phone:712-253-0990
Practice Address - Fax:712-255-9490
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer