1053757559 NPI number — GENESIS REHABILITATION SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053757559 NPI number — GENESIS REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS REHABILITATION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053757559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 PORTRAIT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWLEYS ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29585-6532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 LAKES AT LITCHFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWLEYS ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29585-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-235-2814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SALSGIVER
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
954-809-5130

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  6547 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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