Contract Details
Legacy Therapy & Wellness
Facility name
Legacy Therapy & Performance
Provider ID
P000009078
Tax ID
200028986
Effective Date
2/9/2018
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
2/10/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
205 Graceland Drive Suite 8
Dothan, AL 36305
United States
County
Houston
Phone
3346992348 (Phone)
Billing Details
Address
205 Graceland Drive
Suite 8
Dothan, AL 36305
Billing Phone
3346992348
Specialty Type
Physical Therapy
Map
Address