Contract Details
Ancillary Care Services
Facility name
Northside Physical Therapy & Rehabilitation
Provider ID
P000005845
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
416 Treemont Drive
Orange City, FL 32763
United States
County
Volusia
Phone
3867744840 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address