Contract Details
Southern Physical Rehab Network
Facility name
TherapySouth Liberty Park
Provider ID
P000002468
NPI
1730481029
Tax ID
273643259
Effective Date
1/1/2009
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
9/3/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3800 River Run Drive Suite 102
Birmingham, AL 35243
United States
County
Jefferson
Phone
2059702350 (Phone)
Billing Details
Address
109 9th Street Southwest
Suite C
Cullman, AL 35055
Billing Phone
2567369926
Specialty Type
Physical Therapy
Map
Address