1104392174 NPI number — AUBREY LIAN WRIGHT L.M.T.

Table of content: AUBREY LIAN WRIGHT L.M.T. (NPI 1104392174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104392174 NPI number — AUBREY LIAN WRIGHT L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
AUBREY
Provider Middle Name:
LIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
AUBREY
Provider Other Middle Name:
LIAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NONE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104392174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5172 QUITMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80212-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-422-1882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 W 44TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80211-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-581-2220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MT.0018871 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)