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Tyler
Vaughn
RPT
Contract Details
BenchMark Physical Therapy
Facility name
Provider ID
P000008912
NPI
1114455714
Tax ID
300714977
Effective Date
12/17/2018
Last Updated
12/17/2018
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
100 N Florida Street Suite 31
Mobile, AL 36607
United States
County
Mobile
Phone
2513008874
(
Phone
)
Billing Details
Address
6397 Lee Highway
Suite 300
Chattanooga, TN 37421
Billing Phone
2513008874
Specialty Type
Physical Therapy
Map
Address