Provider Demographics
NPI:1437887544
Name:WRIGHT, LORENZO JAMAL
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:JAMAL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 MASON CREEK CIR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7921
Mailing Address - Country:US
Mailing Address - Phone:843-408-1719
Mailing Address - Fax:
Practice Address - Street 1:8154 ENGLISH CLOVER LN
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6935
Practice Address - Country:US
Practice Address - Phone:803-882-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4944225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant