Meredith    Tittle    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004760
NPI
1538205836
Tax ID
204408934
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2652 FM 407 Suite 115
Bartonville, TX 76226
United States
County
Denton
Phone
9402411215 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address