Scott  T  Dewig    RPT
Contract Details
BenchMark Physical Therapy of Alabama, LLC
Facility name
Provider ID
P000008543
NPI
1568798692
Tax ID
300714977
Effective Date
12/30/2016
Last Updated
11/1/2017
Direct Contract
Yes
Term Date
6/19/2017
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3947 Gulf Shores Pkwy Ste 260
Gulf Shores, AL 365422729
United States
County
Baldwin
Phone
2519430803 (Phone)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 373636511
Billing Phone
2519430803
Specialty Type
Physical Therapy
Map
Address