Jeffrey    Turner    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003996
NPI
1194823492
Tax ID
711010881
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
400 North Loop 1604 East Suite 345
San Antonio, TX 78232
United States
County
Bexar
Phone
2104022920 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address