Contract Details
Ancillary Care Services
Facility name
Gold Coast Physical Therapy Associates
Provider ID
P000004881
NPI
1588753388
Tax ID
650859062
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
11120 South Crown Way Suite 8
Wellington, FL 33414
United States
County
Palm Beach
Phone
5616561028 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address