Contract Details
Ancillary Care Services
Facility name
Select Physical Therapy
Provider ID
P000004752
NPI
1538164553
Tax ID
582216877
Effective Date
4/1/2012
Last Updated
4/12/2018
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
6340 Sugarloaf Parkway Suite 125
Duluth, GA 30097
United States
County
Gwinnett
Phone
7704765877 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address