1598727976 NPI number — DRAYER PHYSICAL THERAPY INSTITUTE LLC

Table of content: (NPI 1598727976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598727976 NPI number — DRAYER PHYSICAL THERAPY INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAYER PHYSICAL THERAPY INSTITUTE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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NPI Number Information

NPI Number:
1598727976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 DERRY ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-839-2110
Provider Business Mailing Address Fax Number:
717-565-1934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 PLEASANT VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-4309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-949-9500
Provider Business Practice Location Address Fax Number:
814-949-9550
Provider Enumeration Date:
04/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER PAYER & PROVIDER ENROLLMENT
Authorized Official Telephone Number:
717-839-2156

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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