Tyler    Lee    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004703
NPI
1508873746
Tax ID
581819981
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
Thomasville Physical Therapy 151 MLK, Jr. Avenue Southwest
Cairo, GA 39828
United States
County
Grady
Phone
2293770882 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address