Allison  W  Fowlkes    RPT
Contract Details
TherapySouth--Birmingham-Mountain Brook
Facility name
Provider ID
P000000565
NPI
1245332113
Tax ID
263761856
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
205 Country Club Park
Birmingham, AL 35213
United States
County
Jefferson
Phone
2058710777 (Phone)
Billing Details
Address
2823 Greystone Commercial Boulevard
Birmingham, AL 35242
Billing Phone
2054081713
Specialty Type
Physical Therapy
Map
Address