Rick    Gordon    RPT
Contract Details
Facility name
Provider ID
P000005048
NPI
1669472767
Tax ID
752724249
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4519 North Garfield Suite 5
Midland, TX 79705
United States
County
Midland
Phone
4326838476 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address