MEDICARE: DRAYER PHYSICAL THERAPY - SOUTH CAROLINA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1134794563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAYER PHYSICAL THERAPY - SOUTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	5443 PLATT SPRINGS RD STE D
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6203
Country	:	US
Telephone Number	:	803-774-1333
Fax Number	:	803-767-4918

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN BARGANIER
Credential	:
Telephone Number	:	205-536-7602

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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