Tyler    Vaughn    RPT
Contract Details
Renew PT and Performance
Facility name
Provider ID
P000008912
NPI
1114455714
Tax ID
831599016
Effective Date
1/29/2018
Last Updated
1/30/2019
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
27468 World Court
Daphne, AL 36526
United States
County
Baldwin
Phone
2512701551 (Phone)
Billing Details
Address
27468 World Court
Daphne, AL 36526
Billing Phone
2512701551
Specialty Type
Physical Therapy
Map
Address