Quinn    Millington    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000007424
NPI
1174573844
Tax ID
470907536
Effective Date
1/1/2004
Last Updated
1/19/2016
Direct Contract
Yes
Term Date
1/19/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
PT Solutions of South Montgomery 2065 East South Boulevard
Montgomery, AL 36116
United States
County
Montgomery
Phone
3342888358 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address