Provider Demographics
NPI:1356669964
Name:WRIGHT, WENDY A (LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3833
Mailing Address - Country:US
Mailing Address - Phone:904-368-0011
Mailing Address - Fax:904-368-0013
Practice Address - Street 1:225 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3833
Practice Address - Country:US
Practice Address - Phone:904-368-0011
Practice Address - Fax:904-368-0013
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist