Bradley    Davidson    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005083
NPI
1689616658
Tax ID
611208897
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2024 Alverson Drive
Paris, KY 40361
United States
County
Bourbon
Phone
8599885005 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address