Vicky    Bledsoe    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004142
NPI
1265470231
Tax ID
061671991
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
3636 Executive Center Drive Suite 150
Austin, TX 78731
United States
County
Travis
Phone
5127950053 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address