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General NPI Number Information
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NPI Number | 1477402600
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Entity Type | Individual
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Provider Name | VADIM J DRAKE DPT
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Gender | Male
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 2536 HIGHWAY 49 E STE 130
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City | PLEASANT VIEW
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State | TN
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Zip | 37146-7160
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Country | US
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Telephone | 615-746-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 304 COURT ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-3554
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Country | US
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Telephone | 601-596-7672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 17015
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License Number State | TN
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