Provider Demographics
NPI:1306988464
Name:WRIGHT, LAUREN M (PT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2652
Mailing Address - Country:US
Mailing Address - Phone:402-556-9094
Mailing Address - Fax:
Practice Address - Street 1:1420 S 175TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2652
Practice Address - Country:US
Practice Address - Phone:402-556-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1960225100000X
IA2831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F247453OtherMIDLANDS CHOICE
6400524OtherUNITED HEALTHCARE
NE02042OtherBLUE CROSS BLUE SHIELD
IA0593707Medicaid
Q45450Medicare UPIN
NEP00268761Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IA0593707Medicaid