Provider Demographics
NPI:1669507158
Name:WRIGHT, KIMBERLY SUE (LAC, PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LAC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 WESTERNPORT RD SW
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-2234
Mailing Address - Country:US
Mailing Address - Phone:301-786-4161
Mailing Address - Fax:301-786-4203
Practice Address - Street 1:21907 WESTERNPORT RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2234
Practice Address - Country:US
Practice Address - Phone:301-786-4171
Practice Address - Fax:301-786-4203
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01413171100000X
MD16717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist