Provider Demographics
NPI:1558771691
Name:WRIGHT, KAMALA (LMT)
Entity Type:Individual
Prefix:
First Name:KAMALA
Middle Name:
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 1:1157 SW 123 AVENUE
Mailing Address - Street 2:BLDG 35-1157
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:305-505-9118
Mailing Address - Fax:
Practice Address - Street 1:1157 SW 123RD AVE
Practice Address - Street 2:BLDG 35-1157
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5772
Practice Address - Country:US
Practice Address - Phone:305-505-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73046225700000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL455586271OtherINSURANCE BILLING FOR MASSAGE THERAPY