Healthcare Provider Details

I. General information

NPI: 1760873384
Provider Name (Legal Business Name): JENNIFER DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 MOORE RD
MATTHEWS NC
28105-4978
US

IV. Provider business mailing address

385 SPEARS CREEK CHURCH RD STE B
ELGIN SC
29045-8446
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax: 877-407-4329
Mailing address:
  • Phone: 803-929-7408
  • Fax: 888-711-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8418
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8418
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerPHYSICAL THERAPY LICENSES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: