Mark    Brooks    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005798
NPI
1003807819
Tax ID
611208897
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
880 Corporate Drive Suite 101
Lexington, KY 40503
United States
County
Fayette
Phone
8592234364 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address