Danielle    Kirkpatrick    RPT
Contract Details
Pro Impact Physical Therapy & Sports Performance
Facility name
Provider ID
P000008308
NPI
1922484252
Tax ID
270156341
Effective Date
8/1/2015
Last Updated
8/17/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5923 Monticello Drive
Montgomery, AL 36117
United States
County
Montgomery
Phone
3343566453 (Phone)
Billing Details
Address
5923 Monticello Drive
Montgomery, AL 36117
Billing Phone
3343566453
Specialty Type
Physical Therapy
Map
Address