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General NPI Number Information
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NPI Number | 1437887544
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Entity Type | Individual
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Provider Name | MR. LORENZO JAMAL WRIGHT
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Gender | Male
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 8154 ENGLISH CLOVER LN
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City | INDIAN LAND
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State | SC
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Zip | 29707-6935
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Country | US
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Telephone | 803-882-3199
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Fax |
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Provider Business Mailing Address
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Address Line | 6080 MASON CREEK CIR UNIT 301
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City | INDIAN LAND
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State | SC
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Zip | 29707-7921
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Country | US
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Telephone | 843-408-1719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4944
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License Number State | SC
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