Provider Demographics
NPI:1881904704
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:A
Authorized Official - Last Name:DRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-220-2100
Mailing Address - Street 1:1113 N CASTLE HEIGHTS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5640
Mailing Address - Country:US
Mailing Address - Phone:615-965-9000
Mailing Address - Fax:615-965-9001
Practice Address - Street 1:1113 N CASTLE HEIGHTS AVE
Practice Address - Street 2:STE D
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5640
Practice Address - Country:US
Practice Address - Phone:615-965-9000
Practice Address - Fax:615-965-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2011-03-03
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
TN103G700381Medicare Oscar/Certification