Contract Details
Ancillary Care Services
Facility name
Lago Vista Physical Therapy
Provider ID
P000003608
NPI
1003899782
Tax ID
742979344
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
5802 Thunderbird Street
Lago Vista, TX 78645
United States
County
Travis
Phone
5122675400 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address