Contract Details
Southern Physical Rehab Network
Facility name
Eastern Shore Physical Therapy
Provider ID
P000002101
NPI
1700831666
Tax ID
630997518
Effective Date
4/1/2005
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
12/12/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
618 McMeans Avenue
Bay Minette, AL 36507
United States
County
Baldwin
Phone
2519374700 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address