Contract Details
Ancillary Care Services
Facility name
Select Physical Therapy
Provider ID
P000004624
NPI
1477559771
Tax ID
561818102
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
2303 Wellington Drive Southwest Suite B
Wilson, NC 27893
United States
County
Wilson
Phone
2522436818 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address