Richard    Evans    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003878
NPI
1134128531
Tax ID
742586337
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
2040 Babcock Road Suite 101
San Antonio, TX 78229
United States
County
Bexar
Phone
2106927070 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address