Provider Demographics
NPI:1255682951
Name:WRIGHT, JENA ELLIS (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:ELLIS
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 GA HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-4939
Mailing Address - Country:US
Mailing Address - Phone:229-322-8222
Mailing Address - Fax:
Practice Address - Street 1:1107 GREER ST
Practice Address - Street 2:SUITE B
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1920
Practice Address - Country:US
Practice Address - Phone:229-273-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT27780225100000X
GAPT10948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist