Richard    Ezernack    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005542
NPI
1881832384
Tax ID
263977508
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
19770 Kingsland Boulevard Suite 300-B
Houston, TX 77094
United States
County
Harris
Phone
2815787300 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address