MEDICARE: DRAYER PHYSICAL THERAPY INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8783	OTHER	SC	MEDICARE

General Provider Information

NPI Number	:	1184988818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAYER PHYSICAL THERAPY INSTITUTE

Provider Business Mailing Address
First Line	:	3250 HARDEN STREET EXT
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6842
Country	:	US
Telephone Number	:	803-509-6389
Fax Number	:	803-509-6390

Provider Business Practice Location Address
First Line	:	3250 HARDEN STREET EXT
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6842
Country	:	US
Telephone Number	:	803-509-6389
Fax Number	:	803-509-6390

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LUKE A DRAYER
Credential	:
Telephone Number	:	717-220-2100

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	11/27/2012

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