Provider Demographics
NPI:1205612488
Name:WRIGHT, CLIFTON PAUL (LMT)
Entity type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:PAUL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 S SALIX CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5239
Mailing Address - Country:US
Mailing Address - Phone:813-938-9222
Mailing Address - Fax:
Practice Address - Street 1:2532 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1247
Practice Address - Country:US
Practice Address - Phone:801-415-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11481125-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist