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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1760768014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAYER PHYSICAL THERAPY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1553 JANMAR RD
Second Line	:	SUITE B
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5606
Country	:	US
Telephone Number	:	678-987-0250
Fax Number	:	678-987-0217

Provider Business Practice Location Address
First Line	:	1553 JANMAR RD
Second Line	:	SUITE B
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5606
Country	:	US
Telephone Number	:	770-207-6624
Fax Number	:	770-207-6631

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	LUKE A DRAYER
Credential	:
Telephone Number	:	717-220-2100

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/08/2011

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