Contract Details
Facility name
Power Physical Therapy & Wellness Center, PLLC
Provider ID
P000005723
NPI
1962649947
Tax ID
900434836
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1219 Corpus Christi Suite A
Laredo, TX 78040
United States
County
Webb
Phone
9565685032 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address