Donald  W  Blanton    PHD
Contract Details
Selma Rehabilitation Services
Facility name
Provider ID
P000000153
NPI
1548357940
Tax ID
636005396
Effective Date
12/7/2000
Last Updated
6/3/2014
Direct Contract
Yes
Term Date
8/29/2013
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_055
Location Details
Address
1023 Medical Center Parkway Suite 200
Selma, AL 36701
United States
County
Dallas
Phone
3348754184 (Phone)
Billing Details
Address
416 Drayton Drive
Selma, AL 36701
Billing Phone
3348754184
Specialty Type
Physical Medicine & Rehabilitation
Map
Address