Marguerite    McCowan    RPT
Contract Details
TherapySouth--Fultondale
Facility name
Provider ID
P000001093
NPI
1831263136
Tax ID
320221578
Effective Date
2/15/2012
Last Updated
12/19/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
3471 Lowery Parkway Suite 107
Fultondale, AL 35068
United States
County
Jefferson
Phone
2058496566 (Phone)
Billing Details
Address
2823 Greystone Commercial Boulevard
Birmingham, AL 35242
Billing Phone
2054081713
Specialty Type
Physical Therapy
Map
Address