Ed    Preston    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004997
NPI
1649218140
Tax ID
201937120
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2265 Parr Avenue
Dyersburg, TN 38024
United States
County
Dyer
Phone
7312856600 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address