Jerry  L  Klug    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000000924
NPI
1326096405
Tax ID
630797708
Effective Date
11/18/2014
Last Updated
7/3/2019
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
75.00
Location Details
Address
Alabama Physical Rehabilitation Services 1475 First Avenue Southwest
Jacksonville, AL 36265
United States
County
Calhoun
Phone
2564359386 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address