Basic Information
| Provider Information | |||||||||
| NPI: | 1295370948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSICAL THERAPY INSTITUTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4870 MCKNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152373442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128478321 | ||||||||
| FaxNumber: | 4128478541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2019 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | BENETTO | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MGR PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 4232388923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.