Tom  G  Rider    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000007422
NPI
1518044171
Tax ID
631055332
Effective Date
3/9/1998
Last Updated
6/9/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
Physical Therapy of Andalusia 1105 West Bypass
Andalusia, AL 36420
United States
County
Covington
Phone
3342225785 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
Specialty Type
Physical Therapy
Map
Address