Provider Demographics
NPI:1376716126
Name:WAINRIGHT, JAEL (LMT)
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:
Last Name:WAINRIGHT
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 1:579 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1579
Mailing Address - Country:US
Mailing Address - Phone:214-718-8365
Mailing Address - Fax:
Practice Address - Street 1:2100 ROSS AVE
Practice Address - Street 2:960
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2739
Practice Address - Country:US
Practice Address - Phone:214-718-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0230524OtherLABOR & INDUSTRIES