Ashlynn    Goddard-Carter    OTR
Contract Details
BenchMark Physical Therapy of Alabama, LLC
Facility name
Provider ID
P000008931
NPI
1861930638
Tax ID
300714977
Effective Date
8/1/2017
Last Updated
5/31/2018
Direct Contract
Yes
Term Date
5/1/2018
Status
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
Occupational Therapy
Map
Address