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Ethan
Hill
RPT
Contract Details
Benchmark Physical Therapy
Facility name
Provider ID
P000000001
NPI
1477324762
Tax ID
300714977
Effective Date
2/5/2024
Last Updated
2/6/2024
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2846 Moody Pkwy Suite 200
Moody, AL 35004
United States
Phone
205-640-4881
(
Phone
)
Billing Details
Address
8823 Production Lane
Ooltewah, TN 37363
Billing Phone
423-238-7217
Specialty Type
Physical Therapy
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