Michael Anthony    Martinez    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004413
NPI
1386958999
Tax ID
273180157
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
9793 Culebra Road Suite 101
San Antonio, TX 78251
United States
County
Bexar
Phone
2108655598 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address