Contract Details
Ancillary Care Services
Facility name
Northside Physical Therapy & Rehabilitation
Provider ID
P000004253
NPI
1316178783
Tax ID
592979941
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
752 West Plymouth Avenue
Deland, FL 32720
United States
County
Volusia
Phone
3867341136 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address