Tyler    Vaughn    RPT
Contract Details
BenchMark Physical Therapy of Alabama, LLC
Facility name
Provider ID
P000008912
NPI
1114455714
Tax ID
300714977
Effective Date
7/1/2017
Last Updated
5/17/2019
Direct Contract
Yes
Term Date
1/31/2019
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
151 Fly Creek Ave Ste 438
Fairhope, AL 36532
United States
County
Baldwin
Phone
2519289619 (Phone)
Billing Details
Address
6397 Lee Hwy
Suite 300
Chattanooga, TN 37421
Billing Phone
4232387217
Specialty Type
Physical Therapy
Map
Address