Arlie    Etherton    RPT
Contract Details
P4 Physical Therapy
Facility name
Provider ID
P000000001
NPI
1649962754
Tax ID
883148982
Effective Date
6/1/2023
Last Updated
6/5/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
2244 North Road Suite 104
Gardendale, AL 35071
United States
Phone
205-418-0180 (Phone)
Billing Details
Address
8095 Mitchell Lane
Vestavia Hills, AL 35216
Billing Phone
205-418-1080
Specialty Type
Physical Therapy
Map
Address