Provider Demographics
NPI:1891915120
Name:WRIGHT, JASON MICHEAL (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHEAL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WEST JEFFERSON ST.
Mailing Address - Street 2:
Mailing Address - City:STONE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:43840
Mailing Address - Country:US
Mailing Address - Phone:330-308-5695
Mailing Address - Fax:330-897-0515
Practice Address - Street 1:130 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:OH
Practice Address - Zip Code:43804-9669
Practice Address - Country:US
Practice Address - Phone:330-897-4311
Practice Address - Fax:330-897-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant