Kim    Chastain    RPT
Contract Details
Milton Physical Therapy
Facility name
Provider ID
P000008714
NPI
1639231103
Tax ID
815152977
Effective Date
5/24/2017
Last Updated
2/7/2019
Direct Contract
Yes
Term Date
12/31/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
12220 Birmingham Hwy Building 10, Suite C
Milton, GA 30004
United States
County
Fulton
Phone
7708260440 (Phone)
Billing Details
Address
1410 Wood Duck Road
Woodstock, GA 30188
Billing Phone
7708260440
Specialty Type
Physical Therapy
Map
Address