Healthcare Provider Details

I. General information

NPI: 1861054454
Provider Name (Legal Business Name): DRAYER PHYSICAL THERAPY OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13809 S CASPER ST STE A
GLENPOOL OK
74033-2619
US

IV. Provider business mailing address

8205 PRESIDENTS DR FL 2
HUMMELSTOWN PA
17036-8621
US

V. Phone/Fax

Practice location:
  • Phone: 918-528-5620
  • Fax: 918-528-5606
Mailing address:
  • Phone: 717-839-2188
  • Fax: 717-565-1104

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: ROBYN BAILEY
Title or Position: PROVIDER ENROLLMENT CRED SPECIALIST
Credential:
Phone: 717-839-2188