=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861039695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAYER PHYSICAL THERAPY INSTITUTE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2019
-----------------------------------------------------
Last Update Date | 11/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4870 MCKNIGHT RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15237-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-847-8321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 CORPORATE DR STE 400
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-5424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REVENUE CYCLE
-----------------------------------------------------
Name | KEVIN JOHANNESON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-238-2313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------