Individual
MIRANDA NICHOLE WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1285 S MAIN ST, LAKEPORT, CA 95453-5518
(707) 263-5163
(707) 263-5166
Mailing address
1285 S MAIN ST, LAKEPORT, CA 95453-5518
(707) 263-5163
(707) 263-5166
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49270
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
04/06/2018
Last updated
04/06/2018
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