Contract Details
Ancillary Care Services
Facility name
Coastal Therapy
Provider ID
P000005955
Tax ID
582589781
Effective Date
4/1/2012
Last Updated
4/12/2018
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
60 Exchange Street Suite B-4
Richmond Hill, GA 31324
United States
County
Bryan
Phone
9124591270 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address