Provider Demographics
NPI:1801015631
Name:WRIGHT, JAY WILLIAM (PRT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:WILLIAM
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LEWIS AVE S
Mailing Address - Street 2:STE #210
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4500
Mailing Address - Country:US
Mailing Address - Phone:952-955-2242
Mailing Address - Fax:952-955-2010
Practice Address - Street 1:2060 UPPER 55TH ST E
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1725
Practice Address - Country:US
Practice Address - Phone:952-955-2242
Practice Address - Fax:952-955-2010
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN854S0WROtherBCBS MN
MNHP43979OtherHEALTH PARTNERS