Contract Details
Ancillary Care Services
Facility name
Life Therapy Corp
Provider ID
P000004694
NPI
1508171265
Tax ID
900597356
Effective Date
6/28/2012
Last Updated
10/9/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
900 West 49th Street Suite 505
Hialeah, FL 33012
United States
County
Miami-Dade
Phone
3058253666 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address