John    Waggoner    RPT
Contract Details
Spine and Sport Physical Therapy Care
Facility name
Provider ID
P000000001
NPI
1255779922
Tax ID
883323362
Effective Date
4/20/2023
Last Updated
4/26/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
1111 US 72
Killen, AL 35645
United States
Phone
256-715-5868 (Phone)
Billing Details
Address
1111 US 72
Killen, AL 35645
Billing Phone
256-715-5868
Specialty Type
Physical Therapy
Website
Visit Website
Workers Comp Coordinator
John
Waggoner
256-715-5868
jwaggoner@spinesportptcare.com
Map
Address