Provider Demographics
NPI: | 1760880298 |
---|---|
Name: | DPTI-PEAK REHAB LLC |
Entity Type: | Organization |
Organization Name: | DPTI-PEAK REHAB LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHAIRMAN AND FOUNDER |
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: | 1902 SE WASHINGTON BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | BARTLESVILLE |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74006-6736 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-876-1482 |
Mailing Address - Fax: | 918-876-1506 |
Practice Address - Street 1: | 1902 SE WASHINGTON BLVD |
Practice Address - Street 2: | |
Practice Address - City: | BARTLESVILLE |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74006-6736 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-876-1482 |
Practice Address - Fax: | 918-876-1506 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-12-16 |
Last Update Date: | 2015-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |