1689099939 NPI number — DRAYER PHYSICAL THERAPY OF TENNESSEE LLC

Table of content: JOSEPH OSCAR WONG DC (NPI 1104316280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689099939 NPI number — DRAYER PHYSICAL THERAPY OF TENNESSEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAYER PHYSICAL THERAPY OF TENNESSEE 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:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689099939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 BRADFORD BLVD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
GORDONSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38563-4600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-683-3490
Provider Business Mailing Address Fax Number:
615-683-3495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 BRADFORD BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
GORDONSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38563-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-683-3490
Provider Business Practice Location Address Fax Number:
615-683-3495
Provider Enumeration Date:
02/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DRAYER
Authorized Official First Name:
LUKEE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHAIRMAN & CEO
Authorized Official Telephone Number:
717-220-2100

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)





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