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Lara
E
Head
RPT
Contract Details
Premier Physical Therapy
Facility name
Provider ID
P000000736
NPI
1598816845
Tax ID
204897118
Effective Date
3/1/2000
Last Updated
5/16/2016
Direct Contract
Yes
Term Date
5/30/2013
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
7088 University Court
Montgomery, AL 36117
United States
County
Montgomery
Phone
3343961400
(
Phone
)
Billing Details
Address
7088 University Court
Montgomery, AL 36117
Billing Phone
3343961400
Specialty Type
Physical Therapy
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Address