Amar    Patel    RPT
Contract Details
Sparks Physical Therapy
Facility name
Provider ID
P000000001
NPI
1780192419
Tax ID
844073491
Effective Date
2/4/2020
Last Updated
5/18/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3102 Rainbow Drive
Rainbow City, AL 35906
United States
Phone
256-546-8127 (Phone)
Billing Details
Address
199 Brookmoore Drive
Columbus, MS 39705
Billing Phone
256-546-8127
Specialty Type
Physical Therapy
Map
Address