Provider Demographics
NPI:1659379816
Name:DRAYTON, STEPHANIE MARIE (MPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:DRAYTON
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 WARMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-5005
Mailing Address - Country:US
Mailing Address - Phone:215-200-0206
Mailing Address - Fax:
Practice Address - Street 1:700 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4700
Practice Address - Country:US
Practice Address - Phone:717-569-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2325007000OtherKEYSTONE PIN
1648274OtherBC/BS PIN
PA2325007000OtherPC PIN
PA11349967OtherCAQH
PA2325007000OtherPC PIN