Linda    Heinzelman    RPT
Contract Details
Facility name
Provider ID
P000005418
NPI
1811905656
Tax ID
141692740
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
484 Glen St
Glens Falls, NY 12801
United States
County
Warren
Phone
5187981269 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address