Provider Demographics
NPI:1225408511
Name:DRAYER PHYSICAL THERAPY JACKSON LLC
Entity Type:Organization
Organization Name:DRAYER PHYSICAL THERAPY JACKSON LLC
Other - Org Name:BEYOND THERAPY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-220-2100
Mailing Address - Street 1:950 E COUNTY LINE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1928
Mailing Address - Country:US
Mailing Address - Phone:601-853-9147
Mailing Address - Fax:601-898-4761
Practice Address - Street 1:950 E COUNTY LINE RD
Practice Address - Street 2:SUITE E
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1928
Practice Address - Country:US
Practice Address - Phone:601-853-9147
Practice Address - Fax:601-898-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty