Contract Details
Ancillary Care Services
Facility name
Weston Physical Medicine
Provider ID
P000005208
NPI
1720342512
Tax ID
455501029
Effective Date
9/27/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1398 Southwest 160 Avenue Suite 102
Sunrise, FL 33326
United States
County
Broward
Phone
9543842925 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address