Contract Details
Ancillary Care Services
Facility name
Foundation Physical Therapy
Provider ID
P000004726
NPI
1518902832
Tax ID
593737744
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
29605 Highway 19 North Suite 360
Clearwater, FL 33761
United States
County
Pinellas
Phone
7277846088 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address