Provider Demographics
NPI:1609646330
Name:WRIGHT, JEREMIAH ISAIAH MORGAN (PTA)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:ISAIAH MORGAN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 ENCHANTED WIND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7524
Mailing Address - Country:US
Mailing Address - Phone:915-861-4211
Mailing Address - Fax:
Practice Address - Street 1:1351 N ZARAGOZA RD BLDG G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7902
Practice Address - Country:US
Practice Address - Phone:915-444-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2110530225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant