Contract Details
Ancillary Care Services
Facility name
Carthage Physical Therapy
Provider ID
P000005336
NPI
1780779215
Tax ID
200013189
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
107 South Daniels Street
Carthage, TX 75633
United States
County
Panola
Phone
9036949371 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address