Provider Demographics
NPI:1467084624
Name:DRAYER PHYSCIAL THERAPY OF MARYLAND, LLC
Entity Type:Organization
Organization Name:DRAYER PHYSCIAL THERAPY OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PAYOR AND PROV ENROLLMEN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-238-8923
Mailing Address - Street 1:5300 DERRY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:7850 ROSSVILLE BLVD STE 206-208
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3934
Practice Address - Country:US
Practice Address - Phone:410-931-2738
Practice Address - Fax:410-931-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy