Contract Details
A Physiotherapy Associates Company
Facility name
Champion Sports Medicine & Rehabilitation Center - Fairhope
Provider ID
P000002048
NPI
1528359288
Tax ID
721379381
Effective Date
8/28/1995
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
6/29/2012
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
908 Plantation Boulevard
Fairhope, AL 36532
United States
County
Baldwin
Phone
2515173304 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address