Travis    Sterling    RPT
Contract Details
Facility name
Provider ID
P000004435
NPI
1396876496
Tax ID
208578030
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2607 Washington St
Pella, IA 50219
United States
County
Marion
Phone
6416211401 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address