Provider Demographics
NPI:1831490630
Name:DRAYER PHYSICAL THERAPY INSTITUTE LLC
Entity type:Organization
Organization Name:DRAYER PHYSICAL THERAPY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-220-2100
Mailing Address - Street 1:112 BRADFORD BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4600
Mailing Address - Country:US
Mailing Address - Phone:615-683-3490
Mailing Address - Fax:615-683-3495
Practice Address - Street 1:112 BRADFORD BLVD
Practice Address - Street 2:STE 500
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563-4600
Practice Address - Country:US
Practice Address - Phone:615-683-3490
Practice Address - Fax:615-683-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G700381Medicare Oscar/Certification