Reza    Nabavi    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005819
NPI
1689726960
Tax ID
752318416
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
7130 Campbell Road Suite 207
Dallas, TX 75248
United States
County
Dallas
Phone
9722705555 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address