Jeffrey Scott    Borcik    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004670
NPI
1487976478
Tax ID
271778064
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
15302 Spring Falls
San Antonio, TX 78247
United States
County
Bexar
Phone
2107814810 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address