Mike  L  Jones    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000000858
NPI
1861479388
Tax ID
631050487
Effective Date
8/28/1995
Last Updated
8/30/2016
Direct Contract
Yes
Term Date
3/31/2011
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
Rehab South 2980 Highway 78 East
Jasper, AL 35501
United States
County
Walker
Phone
2053841941 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address