Karen  L  Richardson    RPT
Contract Details
Facility name
Provider ID
P000004854
NPI
1578558029
Tax ID
753073672
Effective Date
4/1/2012
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
402 East Zavala St Suite 1
Crystal City, TX 78839
United States
County
Zavala
Phone
2109122982 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address