David  A  Bishop    RPT
Contract Details
Southern Physical Rehab Network
Facility name
Provider ID
P000000136
NPI
1053315994
Tax ID
631038932
Effective Date
7/1/1998
Last Updated
6/9/2014
Direct Contract
Yes
Term Date
8/30/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
Rehab Partners--Ft. Payne 121 Drinkard Drive
Fort Payne, AL 35967
United States
County
De Kalb
Phone
2569979006 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address