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Contract Details
A Physiotherapy Associates Company
Facility name
Champion Sports Medicine & Rehabilitation
Provider ID
P000002044
NPI
1659380160
Tax ID
721379381
Effective Date
1/1/2005
Last Updated
4/12/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2470 Rocky Ridge Road Suite 102
Birmingham, AL 35243
United States
County
Jefferson
Phone
2058244525
(
Phone
)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address