Provider Demographics
NPI:1750792958
Name:DRAYER PHYSCIAL THERAPY OF MARYLAND, LLC
Entity type:Organization
Organization Name:DRAYER PHYSCIAL THERAPY OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PAYOR & PROV ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-238-8923
Mailing Address - Street 1:8205 PRESIDENTS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8621
Mailing Address - Country:US
Mailing Address - Phone:717-839-2159
Mailing Address - Fax:717-565-1104
Practice Address - Street 1:7850 ROSSVILLE BLVD STE 206-208
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3934
Practice Address - Country:US
Practice Address - Phone:410-931-2738
Practice Address - Fax:410-931-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty