Provider Demographics
NPI:1558323535
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 1:506 MARWALT LN
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-2130
Mailing Address - Country:US
Mailing Address - Phone:814-224-1370
Mailing Address - Fax:814-224-1371
Practice Address - Street 1:506 MARWALT LN
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-2130
Practice Address - Country:US
Practice Address - Phone:814-224-1370
Practice Address - Fax:814-224-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075125Medicare Oscar/Certification