Dallas    Williams    RPT
Contract Details
Facility name
Provider ID
P000005075
NPI
1679667695
Tax ID
752907012
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
127 Medical Park Ln
Huntsville, TX 77340
United States
County
Walker
Phone
9362940283 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address