Contract Details
Southern Physical Rehab Network
Facility name
Eastern Shore Physical Therapy
Provider ID
P000002101
NPI
1700831666
Tax ID
630997518
Effective Date
4/1/2005
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
12/12/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
6475 Van Buren Street Suite 102
Daphne, AL 36526
United States
County
Baldwin
Phone
2516269052 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address