Basic Information
| Provider Information | |||||||||
| NPI: | 1467084624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRAYER PHYSCIAL THERAPY OF MARYLAND, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 7850 ROSSVILLE BLVD STE 206-208 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212363934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109312738 | ||||||||
| FaxNumber: | 4109312739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2020 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENETTO | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF PAYOR AND PROV ENROLLMEN | ||||||||
| AuthorizedOfficialTelephone: | 4232388923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.