Donald  L  Smith    RPT
Contract Details
Drayer Physical Therapy Institute--Gardendale
Facility name
Provider ID
P000001628
NPI
1205979648
Tax ID
753050291
Effective Date
12/1/2010
Last Updated
8/26/2014
Direct Contract
Yes
Term Date
5/31/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
651 Main Street Suite 119
Gardendale, AL 35071
United States
County
Jefferson
Phone
2056083113 (Phone)
Billing Details
Address
651 Main Street
Suite 119
Gardendale, AL 35071
Billing Phone
2056083113
Specialty Type
Physical Therapy
Map
Address