Contract Details
Southern Physical Rehab Network
Facility name
Azalea City Hand & Rehab
Provider ID
P000002004
NPI
1760588503
Tax ID
721345437
Effective Date
8/10/2000
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
11/12/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
316 South Sage Avenue Suite C
Mobile, AL 36606
United States
County
Mobile
Phone
2514707772 (Phone)
Billing Details
Address
316 South Sage Avenue
Suite C
Mobile, AL 36606
Billing Phone
2514707772
Specialty Type
Physical Therapy
Map
Address