Provider Demographics
NPI:1801263231
Name:WRIGHT, CANDACE (PTA)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 THE SQUARE AT LILLINGTON
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-8030
Mailing Address - Country:US
Mailing Address - Phone:910-893-2850
Mailing Address - Fax:910-984-1515
Practice Address - Street 1:2 THE SQUARE AT LILLINGTON
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8030
Practice Address - Country:US
Practice Address - Phone:910-893-2850
Practice Address - Fax:910-984-1515
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NCA7197225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty