Contract Details
Ancillary Care Services
Facility name
Coast Physical Therapy
Provider ID
P000003714
NPI
1053483685
Tax ID
593193276
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
500 North Washington Avenue Suite 107
Titusville, FL 32796
United States
County
Brevard
Phone
3212690800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address