Provider Demographics
NPI:1174093652
Name:DRAYER PHYSICAL THERAPY-ALABAMA, LLC
Entity type:Organization
Organization Name:DRAYER PHYSICAL THERAPY-ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAAGER OF PROV & PAYOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-839-2156
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:1215 CHESNUT BYP STE B
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-2830
Practice Address - Country:US
Practice Address - Phone:256-266-1001
Practice Address - Fax:256-266-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy