Provider Demographics
NPI:1992260590
Name:WRIGHT, DEVAN PAUL (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:DEVAN
Middle Name:PAUL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8690
Mailing Address - Country:US
Mailing Address - Phone:636-329-9672
Mailing Address - Fax:
Practice Address - Street 1:4615 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8690
Practice Address - Country:US
Practice Address - Phone:636-329-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019004008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist