Contract Details
Ancillary Care Services
Facility name
South Coast Physical Therapy
Provider ID
P000003889
NPI
1134274749
Tax ID
592788680
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Term Date
10/1/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4999 West 8th Avenue Suite 6
Hialeah, FL 33012
United States
County
Miami-Dade
Phone
3058210100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address