Contract Details
Ancillary Care Services
Facility name
Performance Rehab Institute & Sports Medicine
Provider ID
P000004538
NPI
1437264520
Tax ID
010622972
Effective Date
4/1/2012
Last Updated
4/12/2018
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3450 East Lake Road Suite 101
Palm Harbor, FL 34685
United States
County
Pinellas
Phone
7277811223 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address