Contract Details
Facility name
Innovative Physical Therapy
Provider ID
P000004650
NPI
1487658050
Tax ID
742920275
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
2414 Babcock Rd Suite 102A
San Antonio, TX 78229
United States
County
Bexar
Phone
2105930510 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address