Provider Demographics
NPI:1336483940
Name:WRIGHT, KRISTIN ELLEN (PTA)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELLEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WHITE RIVER DR UNIT 26D
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1332
Mailing Address - Country:US
Mailing Address - Phone:203-278-1377
Mailing Address - Fax:
Practice Address - Street 1:501 WHITE RIVER DR UNIT 26D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-1332
Practice Address - Country:US
Practice Address - Phone:203-278-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10194225200000X
SC4424225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant