Contract Details
Ancillary Care Services
Facility name
Select Physical Therapy
Provider ID
P000004296
NPI
1336149848
Tax ID
582304502
Effective Date
4/1/2012
Last Updated
10/17/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
7 South Alliance Drive Suite 102-A
Goose Creek, SC 29445
United States
County
Berkeley
Phone
8435692303 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address