Lori  C  Riegle    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000001462
NPI
1659485068
Tax ID
753251370
Effective Date
1/1/2009
Last Updated
6/9/2014
Direct Contract
Yes
Term Date
9/3/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
TherapySouth--McCalla/Bessemer 4765 Eastern Valley Road, Suite 109
Mc Calla, AL 35111
United States
County
Tuscaloosa
Phone
2054771501 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address