Contract Details
Southern Physical Rehab Network
Facility name
TherapySouth Glusckstadt
Provider ID
P000009372
NPI
1134784689
Tax ID
833923393
Effective Date
1/1/2019
Last Updated
11/15/2021
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1716 US 51 Suite N
Madison, MS 39110
United States
County
Madison
Phone
6014995780 (Phone)
Billing Details
Address
1716 US 51
Suite N
Madison, MS 39110
Billing Phone
6014995780
Specialty Type
Physical Therapy
Map
Address