Basic Information
| Provider Information | |||||||||
| NPI: | 1346610151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSICAL THERAPY MISSISSIPPI LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 BROOKMOORE DRIVE | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623276705 | ||||||||
| FaxNumber: | 6623276760 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 N WALMART DR STE F | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393396898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172202100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 12/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | HESS | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7178392128 | ||||||||
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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.