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Contract Details
Lake Martin Physical Therapy
Facility name
Provider ID
P000001662
NPI
1669479754
Tax ID
721379419
Effective Date
1/20/2017
Last Updated
1/20/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1120 Airport Drive Suite 103
Alexander City, AL 35010
United States
County
Tallapoosa
Phone
2563298180 (Phone)
Billing Details
Address
1120 Airport Drive
Suite 103
Alexander City, AL 35010
Billing Phone
2563298180
Specialty Type
Physical Therapy
Map
Address