Anthony    Davison    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005684
NPI
1952303406
Tax ID
300167919
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
2901 West FM 544 Suite 140
Wylie, TX 75098
United States
County
Collin
Phone
9724421177 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address