Michael    Clark    RPT
Contract Details
Bayside Physical Therapy, LLC
Facility name
Provider ID
P000000001
NPI
1336147289
Tax ID
834580373
Effective Date
8/1/2020
Last Updated
9/8/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
341 North Green Road Suite 102
Fairhope, AL 36532
United States
Phone
251-928-9954 (Phone)
Billing Details
Address
341 North Green Road
Suite 102
Fairhope, AL 36532
Billing Phone
251-928-9954
Specialty Type
Physical Therapy
Map
Address