Doug    Cole    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000007436
NPI
1134234537
Tax ID
208098768
Effective Date
1/1/2009
Last Updated
6/9/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
TherapySouth--Talladega 727 Stone Avenue
Talladega, AL 35160
United States
County
Talladega
Phone
2563159693 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address