Marguerite    McCowan    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000001093
NPI
1831263136
Tax ID
320221578
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--Fultondale 3471 Lowery Parkway, Suite 107
Fultondale, AL 35068
United States
County
Jefferson
Phone
2058496566 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address