Provider Demographics
NPI:1497047716
Name:WRIGHT, AMBER LYNAE (FSM,TB)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNAE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FSM,TB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 RIVER TERRACE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022
Mailing Address - Country:US
Mailing Address - Phone:269-993-5435
Mailing Address - Fax:
Practice Address - Street 1:185 RIVER TERRACE DR
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-5052
Practice Address - Country:US
Practice Address - Phone:269-993-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist