Michael Ellis    Charles    RPT
Contract Details
Pro Impact Physical Therapy & Sports Performance
Facility name
Provider ID
P000000288
Tax ID
270156341
Effective Date
12/1/2009
Last Updated
6/9/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5923 Monticello Drive
Montgomery, AL 36117
United States
County
Montgomery
Phone
3343566453 (Phone)
Billing Details
Address
7017 Wynlakes Boulevard
Montgomery, AL 36117
Billing Phone
3343566453
Specialty Type
Physical Therapy
Map
Address