Provider Demographics
NPI:1346486123
Name:WRIGHT, JACQUELINE N (PT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:N
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:D
Other - Last Name:NAGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7900 E RIDGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9516
Mailing Address - Country:US
Mailing Address - Phone:315-637-8046
Mailing Address - Fax:
Practice Address - Street 1:7900 E RIDGE POINTE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9516
Practice Address - Country:US
Practice Address - Phone:315-637-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist