Mary Katherine    Graham    RPT
Contract Details
P4 Physical Therapy
Facility name
Provider ID
P000000001
NPI
1609652668
Tax ID
883148972
Effective Date
1/11/2024
Last Updated
1/17/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
2422 Danville Road SW Suite B
Decatur, AL 35603
United States
Phone
2562745540 (Phone)
Billing Details
Address
2422 Danville Road SW
Suite B
Decatur, AL 35603
Billing Phone
2562745540
Specialty Type
Physical Therapy
Map
Address