Timothy    Moore    MD
Contract Details
BenchMark Physical Therapy of Alabama
Facility name
Provider ID
P000009237
NPI
1942665559
Tax ID
300714977
Effective Date
10/1/2018
Last Updated
10/3/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
12110 County Line Road Suite B
Madison, AL 35756
United States
County
Limestone
Phone
2562329001 (Phone)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 37363
Billing Phone
4232387217
Specialty Type
Physical Therapy
Map
Address