John    Speights    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005463
NPI
1841277118
Tax ID
742962781
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
1810 East 8th Street
Weslaco, TX 78596
United States
County
Hidalgo
Phone
9569689392 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address