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Braxton
Hancock
RPT
Contract Details
BenchMark Physical Therapy
Facility name
Provider ID
P000000001
NPI
1487228003
Tax ID
300714977
Effective Date
6/1/2022
Last Updated
6/17/2022
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
7721 Airport Blvd Suite E120
Mobile, AL 36608
United States
Phone
251-631-3680
(
Phone
)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 37363
Billing Phone
423-238-7217
Specialty Type
Physical Therapy
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