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Kimberly
Williams
OTR
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000001875
Tax ID
630797708
Effective Date
8/28/1995
Last Updated
6/9/2014
Direct Contract
Yes
Term Date
8/30/2013
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
Alabama Physical Rehabilitation Services 1475 First Avenue Southwest
Jacksonville, AL 36265
United States
County
Calhoun
Phone
2564329386
(
Phone
)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Occupational Therapy
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