Contract Details
Ancillary Care Services
Facility name
Andrada Physical Therapy
Provider ID
P000005504
NPI
1861671935
Tax ID
352302092
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3046 Castlewoods Drive
Macon, GA 31204
United States
County
Bibb
Phone
4784057010 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address