Elizabeth Ann    Dessner    RPT
Contract Details
Facility name
Provider ID
P000005149
NPI
1700104833
Tax ID
271976483
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
2109 Cedarwood Dr Suite 200
Muscatine, IA 52761
United States
County
Muscatine
Phone
5632360557 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address