Provider Demographics
NPI:1114011301
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:
Authorized Official - Last Name:DRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-220-2100
Mailing Address - Street 1:38 SHERIDAN PARK CIR
Mailing Address - Street 2:STE C
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7022
Mailing Address - Country:US
Mailing Address - Phone:843-815-5628
Mailing Address - Fax:843-815-5637
Practice Address - Street 1:38 SHERIDAN PARK CIR
Practice Address - Street 2:STE C
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7022
Practice Address - Country:US
Practice Address - Phone:843-815-5628
Practice Address - Fax:843-815-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-02-09
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
SCDF9421OtherRAILROAD GROUP #
SC8783Medicare PIN