Provider Demographics
NPI:1083976914
Name:DRAYER PHYSICAL THERAPY INSTITUTE, LLC
Entity Type:Organization
Organization Name:DRAYER PHYSICAL THERAPY INSTITUTE, LLC
Other - Org Name:ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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 1:140 SHEN ELK PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1165
Mailing Address - Country:US
Mailing Address - Phone:540-298-4749
Mailing Address - Fax:540-298-4570
Practice Address - Street 1:140 SHEN ELK PLZ
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1165
Practice Address - Country:US
Practice Address - Phone:540-298-4749
Practice Address - Fax:540-298-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2014-02-12
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
VA9766Medicare PIN