Elizabeth    Funk    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005384
NPI
1801027438
Tax ID
582529505
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
4274 Washington Road
Evans, GA 30809
United States
County
Columbia
Phone
8034410025 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address