Provider Demographics
NPI:1124652391
Name:WRIGHT, BOBBY JAMES
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:JAMES
Last Name:WRIGHT
Suffix:
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 1:1722 OLIVE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1700
Mailing Address - Country:US
Mailing Address - Phone:314-599-3203
Mailing Address - Fax:
Practice Address - Street 1:1722 OLIVE ST STE 212
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1700
Practice Address - Country:US
Practice Address - Phone:314-599-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist