Contract Details
Ancillary Care Services
Facility name
Sports Specialty & Rehab Center
Provider ID
P000005039
NPI
1659697480
Tax ID
650688953
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4316 Lee Boulevard Suite 12-B
Lehigh Acres, FL 33971
United States
County
Lee
Phone
2393687744 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address