Contract Details
Ancillary Care Services
Facility name
Performance Physical Therapy & Sports Medicine
Provider ID
P000005376
NPI
1790952273
Tax ID
331204555
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
19053 I-45 Suite B
Conroe, TX 77385
United States
County
Montgomery
Phone
9363211101 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address