Basic Information
| Provider Information | |||||||||
| NPI: | 1891915120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MICHEAL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 WEST JEFFERSON ST. | ||||||||
| Address2: | |||||||||
| City: | STONE CREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303085695 | ||||||||
| FaxNumber: | 3308970515 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 BUENA VISTA ST | ||||||||
| Address2: | |||||||||
| City: | BALTIC | ||||||||
| State: | OH | ||||||||
| PostalCode: | 438049669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308974311 | ||||||||
| FaxNumber: | 3308970515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 05806 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.