Suzy    Triplett    RPT
Contract Details
Impact Rehabilitation and Sports Medicine, Inc.
Facility name
Provider ID
P000001761
NPI
1881790640
Tax ID
043685003
Effective Date
7/20/2006
Last Updated
6/10/2016
Direct Contract
Term Date
5/30/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
101 Carrington Lane Suite 3
Calera, AL 35040
United States
County
Shelby
Phone
2056213077 (Phone)
Billing Details
Address
P.O. Box 1694
Calera, AL 35040
Specialty Type
Physical Therapy
Map
Address