Healthcare Provider Details

I. General information

NPI: 1174093652
Provider Name (Legal Business Name): DRAYER PHYSICAL THERAPY-ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CHESNUT BYP STE B
CENTRE AL
35960-2830
US

IV. Provider business mailing address

199 N BROOKMOORE DR
COLUMBUS MS
39705-2024
US

V. Phone/Fax

Practice location:
  • Phone: 256-266-1001
  • Fax: 256-266-1071
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA GARDNER
Title or Position: MANAAGER OF PROV & PAYOR ENROLLMENT
Credential:
Phone: 717-839-2156