Provider Demographics
NPI:1013213792
Name:WRIGHT, JEFFREY (LMP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13252 101ST LN NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9028
Mailing Address - Country:US
Mailing Address - Phone:425-301-4099
Mailing Address - Fax:
Practice Address - Street 1:13252 101ST LN NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9028
Practice Address - Country:US
Practice Address - Phone:425-301-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60113267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist