Reza    Nabavi    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004535
NPI
1437201308
Tax ID
752445786
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
2525 East Highway 175 Suite A
Kaufman, TX 75142
United States
County
Kaufman
Phone
9722705555 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address