Healthcare Provider Details

I. General information

NPI: 1659818375
Provider Name (Legal Business Name): DRAYER PHYSICAL THERAPY OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412A BATTLEGROUND DRIVE
IUKA MS
38852-1309
US

IV. Provider business mailing address

2416 HIGHWAY 45 N
COLUMBUS MS
39705-1320
US

V. Phone/Fax

Practice location:
  • Phone: 662-593-3111
  • Fax: 662-593-3151
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIC J WILLIAMS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 717-220-2100