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Contract Details
Active Health & Rehab
Facility name
Provider ID
P000007111
NPI
1982662870
Tax ID
200250201
Effective Date
10/20/2004
Last Updated
2/1/2019
Direct Contract
Yes
Term Date
12/31/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
70.00
Location Details
Address
3442 Eastdale Circle
Montgomery, AL 36117
United States
County
Montgomery
Phone
3342795757 (Phone)
Billing Details
Address
3442 Eastdale Circle
Montgomery, AL 36117
Billing Phone
3342795757
Specialty Type
Physical Therapy
Map
Address