Provider Demographics
NPI:1467162842
Name:WRIGHT, SHAQUAI JAVARI
Entity Type:Individual
Prefix:
First Name:SHAQUAI
Middle Name:JAVARI
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 1:1573 SKEET CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8065
Mailing Address - Country:US
Mailing Address - Phone:336-967-1723
Mailing Address - Fax:
Practice Address - Street 1:1573 SKEET CLUB RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8065
Practice Address - Country:US
Practice Address - Phone:336-967-1723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant