Darbi    Jackson    RPT
Contract Details
Facility name
Provider ID
1508852278
Tax ID
630815380
Effective Date
2/1/2020
Last Updated
2/28/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
4300 W. Main Street Suite 14
Dothan, AL 36305
United States
Phone
334-758-8288 (Phone)
Billing Details
Address
1711 College Avenue
Jackson, AL 36545
Billing Phone
251-246-5761
Specialty Type
Physical Therapy
Map
Address