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Cory
Stephens
RPT
Contract Details
BenchMark Physical Therapy - Hoover
Facility name
Provider ID
P000009120
NPI
1720503022
Tax ID
300714977
Effective Date
4/2/2018
Last Updated
4/18/2018
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1713 Montgomery Highway South Suite 131
Hoover, AL 35244
United States
County
Jefferson
Phone
2054038701
(
Phone
)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 37363
Billing Phone
4232387217
Specialty Type
Physical Therapy
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Address