Provider Demographics
NPI:1629400189
Name:DRAYER PHYSICAL THERAPY-ALABAMA, LLC
Entity Type:Organization
Organization Name:DRAYER PHYSICAL THERAPY-ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN AND CEO
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 1:42417 HIGHWAY 195
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7198
Mailing Address - Country:US
Mailing Address - Phone:205-486-8811
Mailing Address - Fax:205-486-8812
Practice Address - Street 1:42417 HIGHWAY 195
Practice Address - Street 2:SUITE 100
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7198
Practice Address - Country:US
Practice Address - Phone:205-486-8811
Practice Address - Fax:205-486-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2014-08-04
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
AL102G704409Medicare Oscar/Certification