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General NPI Number Information
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NPI Number | 1275198152
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Entity Type | Organization
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Legal Business Name | DRAYER PHYSICAL THERAPY - SOUTH CAROLINA, LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 135 BLYTHEWOOD RD STE J
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8426
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Country | US
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Telephone | 803-851-1037
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Fax | 803-851-1820
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Provider Business Mailing Address
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Address Line | 135 BLYTHEWOOD RD STE J
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8426
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Country | US
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Telephone | 803-851-1037
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Fax | 803-851-1820
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Authorized Official
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Title or Position | VICE PRESIDENT OF REVENUE CYCLE
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Name | KEVIN JOHANNESON
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Credential |
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Telephone | 423-238-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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