Wayne    Dodd    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005380
NPI
1790995892
Tax ID
742778378
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
495 Amelia Earhart Drive Suite B
Brownsville, TX 78520
United States
County
Cameron
Phone
9565467777 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address