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NPI Code Detail

MEDICARE: DRAYER PHYSICAL THERAPY INSTITUTE LLC

MEDICARE: DRAYER PHYSICAL THERAPY INSTITUTE 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
1225100000XPhysical Therapist
2261QM1300XMulti-Specialty Clinic/Center
3261QX0100XOccupational Medicine Clinic/Center
4261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1598727976
Entity Type Code : Organization
Provider Name (Legal Business Name) : DRAYER PHYSICAL THERAPY INSTITUTE LLC
Provider Business Mailing Address
First Line : 5300 DERRY ST FL 2
Second Line :
City : HARRISBURG
State : PA
Zip : 17111-3576
Country : US
Telephone Number : 717-839-2110
Fax Number : 717-565-1934
Provider Business Practice Location Address
First Line : 3120 PLEASANT VALLEY BLVD
Second Line :
City : ALTOONA
State : PA
Zip : 16602-4309
Country : US
Telephone Number : 814-949-9500
Fax Number : 814-949-9550
Authorized Official
Title or Position : MANAGER PAYER & PROVIDER ENROLLMENT
Name : PAMELA GARDNER
Credential :
Telephone Number : 717-839-2156
Provider Enumeration Date : 04/03/2006
Last Update Date : 03/12/2019

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