Contract Details
Lifebridge Sports Medicine & Rehabilitation, LLC
Facility name
Lifebridge Sports Medicine & Rehabilitation, LLC
Provider ID
P000002232
NPI
1922396100
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
9712 Belair Rd Suite 101-A
Nottingham, MD 212361103
United States
County
Baltimore
Phone
4102567070 (Phone)
Billing Details
Address
PO Box 636002
Littleton, CO 801636002
Billing Phone
3036942295
Specialty Type
Physical Therapy
Map
Address