Healthcare Provider Details

I. General information

NPI: 1942510367
Provider Name (Legal Business Name): KATHRYN LEE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN LEE WRIGHT PT

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 COLLINS ST
MANTECA CA
95337-8641
US

IV. Provider business mailing address

102 W BIANCHI RD
STOCKTON CA
95207-7132
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-8603
  • Fax: 209-951-0448
Mailing address:
  • Phone: 209-957-8603
  • Fax: 209-951-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: