Contract Details
Lifebridge Sports Medicine & Rehabilitation, LLC
Facility name
Lifebridge Sports Medicine & Rehabilitation, LLC
Provider ID
P000002231
NPI
1902184013
Tax ID
382617193
Effective Date
7/21/2011
Last Updated
4/12/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2014 Tollgate Rd Suite 106
Bel Air, MD 210155906
United States
County
Harford
Phone
4105151260 (Phone)
Billing Details
Address
PO Box 636002
Littleton, CO 801636002
Billing Phone
3036942295
Specialty Type
Physical Therapy
Map
Address