Contract Details
Ancillary Care Services
Facility name
Physical Therapy Providers
Provider ID
P000004181
NPI
1275679441
Tax ID
742936369
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1612 North Main Avenue
San Antonio, TX 78212
United States
County
Bexar
Phone
2102262101 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address