Contract Details
A Physiotherapy Associates Company
Facility name
Champion Sports Medicine & Rehabilitation Center - Samford University
Provider ID
P000007382
NPI
1053660597
Tax ID
721379381
Effective Date
2/1/2006
Last Updated
2/8/2019
Direct Contract
Yes
Term Date
12/1/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
800 Lakeshore Drive
Birmingham, AL 35229
United States
County
Jefferson
Phone
2057264311 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address