Contract Details
Ancillary Care Services
Facility name
Onsite Rehab
Provider ID
P000004924
NPI
1609077833
Tax ID
582273537
Effective Date
4/1/2012
Last Updated
4/12/2018
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1266 West Paces Ferry Road Northwest Suite 676
Atlanta, GA 30327
United States
County
Fulton
Phone
4048752323 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address