George    Homan    RPT
Contract Details
BenchMark Physical Therapy - Moody
Facility name
Provider ID
P000009294
NPI
1689129520
Tax ID
300714977
Effective Date
1/7/2019
Last Updated
5/17/2019
Direct Contract
Yes
Term Date
4/30/2019
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
Physical Therapy
Map
Address