Basic Information
| Provider Information | |||||||||
| NPI: | 1750833612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSICAL THERAPY OKLAHOMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2416 HIGHWAY 45 N | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397051320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623276705 | ||||||||
| FaxNumber: | 6623276760 | ||||||||
| Practice Location | |||||||||
| Address1: | 9455 N OWASSO EXPY | ||||||||
| Address2: | SUITE H, TYANN PLAZA | ||||||||
| City: | OWASSO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740555440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183765077 | ||||||||
| FaxNumber: | 9183765078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 12/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND 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.