Healthcare Provider Details

I. General information

NPI: 1043369846
Provider Name (Legal Business Name): JEAN ANNE WRIGHT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VICTORY RD
QUINCY MA
02171-3139
US

IV. Provider business mailing address

28 MATTHEW LN
MANSFIELD MA
02048-3256
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-1040
  • Fax:
Mailing address:
  • Phone: 508-339-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number6492
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: