1376975888 NPI number — DRAYER PHYSICAL THERAPY-SOUTH CAROLINA, LLC

Table of content: HUNG VIET LE DMD (NPI 1740253004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376975888 NPI number — DRAYER PHYSICAL THERAPY-SOUTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAYER PHYSICAL THERAPY-SOUTH CAROLINA, 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:
1376975888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7467 SAINT ANDREWS RD
Provider Second Line Business Mailing Address:
UNIT 9
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-2875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-749-5031
Provider Business Mailing Address Fax Number:
803-749-5032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7467 SAINT ANDREWS RD
Provider Second Line Business Practice Location Address:
UNIT 9
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-5031
Provider Business Practice Location Address Fax Number:
803-749-5032
Provider Enumeration Date:
08/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DRAYER
Authorized Official First Name:
LUKE
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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