Provider Demographics
NPI:1063122190
Name:WRIGHT, ANDRE CERVANTE II
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:CERVANTE
Last Name:WRIGHT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 PRESCOTT CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3049
Mailing Address - Country:US
Mailing Address - Phone:301-848-4535
Mailing Address - Fax:
Practice Address - Street 1:5649 PRESCOTT CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3049
Practice Address - Country:US
Practice Address - Phone:301-848-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation