Contract Details
Ancillary Care Services
Facility name
Physical Therapy & Rehabilitation Clinic
Provider ID
P000005166
NPI
1710040159
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
31 South 5th Street
Macclenny, FL 32063
United States
County
Baker
Phone
9042598343 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address