Provider Demographics
NPI:1083028435
Name:DRAYER PHYSICAL THERAPY MISSISSIPPI LLC
Entity Type:Organization
Organization Name:DRAYER PHYSICAL THERAPY MISSISSIPPI LLC
Other - Org Name:BATSON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & 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 1:711 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-2105
Mailing Address - Country:US
Mailing Address - Phone:601-928-5511
Mailing Address - Fax:601-928-6110
Practice Address - Street 1:711 HALL ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2105
Practice Address - Country:US
Practice Address - Phone:601-928-5511
Practice Address - Fax:601-928-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty