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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
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