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Hannah
Kolomiets
RPT
Contract Details
Results Physiotherapy
Facility name
Provider ID
P000000001
NPI
1275882508
Tax ID
300714977
Effective Date
3/23/2022
Last Updated
1/9/2023
Direct Contract
Yes
Term Date
12/30/2022
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
19495 E Limestone Road Suite B
Harvest, AL 35749
United States
Phone
256-998-5102
(
Phone
)
Fax
256-998-5046
Billing Details
Address
19495 E Limestone Road
Suite B
Ooltewah, TN 35749
Billing Phone
423-238-7217
Specialty Type
Physical Therapy
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Address