Mary Kathryn    Wilcoxson    RPT
Contract Details
P4 Physical Therapy
Facility name
Provider ID
P000000001
NPI
1386122331
Tax ID
883148972
Effective Date
4/26/2024
Last Updated
7/2/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
357 Highway 72
Killen, AL 35645
United States
Phone
256-938-8010 (Phone)
Billing Details
Address
2122 Helton Drive
Florence, AL 35630
Billing Phone
256-938-8010
Specialty Type
Physical Therapy
Map
Address