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Anne
C
Craig
RPT
Contract Details
BenchMark Physical Therapy of Alabama, LLC
Facility name
Provider ID
P000008570
NPI
1033653563
Tax ID
300714977
Effective Date
2/7/2017
Last Updated
5/17/2019
Direct Contract
Yes
Term Date
8/31/2018
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2846 Moody Parkway Suite 200
Moody, AL 35004
United States
County
Saint Clair
Phone
2056404881
(
Phone
)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 37363
Billing Phone
4232387217
Specialty Type
Physical Therapy
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Address