Contract Details
Ancillary Care Services
Facility name
Physical Therapy & Rehabilitation Clinic
Provider ID
P000004709
NPI
1508929779
Tax ID
591802009
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1835 Eastwest Parkway Suite 16
Orange Park, FL 32003
United States
County
Clay
Phone
9042153895 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address