MEDICARE: DRAYER PHYSICAL THERAPY INSTITUTE LLC

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

General Provider Information

NPI Number	:	1396188991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAYER PHYSICAL THERAPY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	130 FORUM DR
Second Line	:	SUITE 13
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7943
Country	:	US
Telephone Number	:	803-509-6880
Fax Number	:	803-509-6881

Provider Business Practice Location Address
First Line	:	130 FORUM DR
Second Line	:	SUITE 13
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7943
Country	:	US
Telephone Number	:	803-509-6880
Fax Number	:	803-509-6881

Authorized Official
Title or Position	:	CHAIRMAN & CEO
Name	:	LUKE A DRAYER
Credential	:
Telephone Number	:	717-220-2100

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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