Healthcare Provider Details

I. General information

NPI: 1386010718
Provider Name (Legal Business Name): DPTI ELITE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 HWY 145
SALTILLO MS
38866
US

IV. Provider business mailing address

2319 HWY 145
SALTILLO MS
38866
US

V. Phone/Fax

Practice location:
  • Phone: 662-869-9980
  • Fax: 662-869-9970
Mailing address:
  • Phone: 662-869-9980
  • Fax: 662-869-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUKE A DRAYER
Title or Position: CHAIRMAN AND FOUNDER
Credential:
Phone: 717-220-2100