MEDICARE: DRAYER PHYSICAL THERAPY INDIANA 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	:	1902449507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAYER PHYSICAL THERAPY INDIANA LLC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 W EADS PKWY
Second Line	:
City	:	LAWRENCEBURG
State	:	IN
Zip	:	47025-1162
Country	:	US
Telephone Number	:	812-577-0921
Fax Number	:	812-577-0922

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN BARGANIER
Credential	:
Telephone Number	:	423-238-7217

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	12/08/2020

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