Basic Information
| Provider Information | |||||||||
| NPI: | 1093063281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSICAL THERAPY INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WILLIAM POPE DRIVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437059440 | ||||||||
| FaxNumber: | 8437059445 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 WILLIAM POPE DRIVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437059440 | ||||||||
| FaxNumber: | 8437059445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | DRAYER | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7172202100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.