1346610151 NPI number — DRAYER PHYSICAL THERAPY MISSISSIPPI LLC

Table of content: (NPI 1346610151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346610151 NPI number — DRAYER PHYSICAL THERAPY MISSISSIPPI LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
DRAYER PHYSICAL THERAPY MISSISSIPPI LLC
Provider Last Name:
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Provider Middle Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1346610151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 BROOKMOORE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-327-6705
Provider Business Mailing Address Fax Number:
662-327-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 N WALMART DR STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39339-6898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-220-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HESS
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
717-839-2128

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)