Provider Demographics
NPI:1083838304
Name:WRIGHT, RACHEL BERNADETTE (LMT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:BERNADETTE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 CHERRY HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6822
Mailing Address - Country:US
Mailing Address - Phone:678-446-6246
Mailing Address - Fax:
Practice Address - Street 1:1035 GREEN ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5466
Practice Address - Country:US
Practice Address - Phone:770-922-7775
Practice Address - Fax:770-922-7775
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA60393OtherMA60393
GAMT001197OtherGEORGIA BOARD OF MASSAGE THERAPY