Contract Details
Ancillary Care Services
Facility name
Sports Specialty & Rehabilitation Center
Provider ID
P000004856
NPI
1578562419
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
2328 Hancock Bridge Parkway Suite 103
Cape Coral, FL 33990
United States
County
Lee
Phone
2395747557 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address