Edwin  P  Grice  III  RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000000653
NPI
1275568743
Tax ID
743044675
Effective Date
3/11/2011
Last Updated
6/9/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
Promise Physical Therapy 640 McQueen Smith Road North
Prattville, AL 36066
United States
County
Autauga
Phone
3343582201 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address