Basic Information
| Provider Information | |||||||||
| NPI: | 1265716153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSICAL THERAPY INSTITUTE LLC | ||||||||
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| OtherOrganizationName: | KENTUCKY HAND - EAGLE CREEK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648866 | ||||||||
| FaxNumber: | 8592641167 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648866 | ||||||||
| FaxNumber: | 8592641167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2011 | ||||||||
| LastUpdateDate: | 01/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | DRAYER | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7172202100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6611590001 | 01 | KY | NSC PTAN | OTHER |