Contract Details
Ancillary Care Services
Facility name
Wellness Therapy Care Center
Provider ID
P000005115
NPI
1689984932
Tax ID
273713182
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
100.00
Location Details
Address
5881 Northwest 151st Street Suite 127
Miami Lakes, FL 33014
United States
County
Miami-Dade
Phone
3058270208 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address