1437572724 NPI number — GENESIS REHAB SERVICES

Table of content: (NPI 1437572724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437572724 NPI number — GENESIS REHAB SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS REHAB 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:
1437572724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 WHITE STONE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33325-3065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-612-1389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 NW 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33150-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-853-5848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARUE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICAL THERAPIST ASST
Authorized Official Telephone Number:
954-612-1389

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  PTA20862 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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