Provider Demographics
NPI:1639770506
Name:WRIGHT, KENDRICK MICHAEL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:MICHAEL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 INDUSTRY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-7893
Mailing Address - Country:US
Mailing Address - Phone:859-298-4356
Mailing Address - Fax:
Practice Address - Street 1:599 INDUSTRY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-7893
Practice Address - Country:US
Practice Address - Phone:859-298-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
KYAT18262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer