Healthcare Provider Details

I. General information

NPI: 1790747772
Provider Name (Legal Business Name): DRAYER PHYSICAL THERAPY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 W SPRING ST
MONROE GA
30655-1756
US

IV. Provider business mailing address

1219 W SPRING ST
MONROE GA
30655-1756
US

V. Phone/Fax

Practice location:
  • Phone: 770-207-6624
  • Fax: 770-207-6631
Mailing address:
  • Phone: 770-207-6624
  • Fax: 770-207-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LUKE DRAYER
Title or Position: CEO
Credential:
Phone: 717-220-2100