Contract Details
Southern Physical Rehab Network
Facility name
Promise Physical Therapy
Provider ID
P000002353
NPI
1598790065
Tax ID
743044675
Effective Date
3/11/2011
Last Updated
4/12/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
640 McQueen Smith Road North
Prattville, AL 36066
United States
County
Autauga
Phone
3343582201 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address