Provider Demographics
NPI:1316087240
Name:GENESIS PHYSICAL THERAPY & REHABILITATION SERVICES
Entity type:Organization
Organization Name:GENESIS PHYSICAL THERAPY & REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SALERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-664-2044
Mailing Address - Street 1:3208 SERVICE DR STE E
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-3539
Mailing Address - Country:US
Mailing Address - Phone:601-664-2044
Mailing Address - Fax:601-664-3044
Practice Address - Street 1:3208 SERVICE DR STE E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3539
Practice Address - Country:US
Practice Address - Phone:601-664-2044
Practice Address - Fax:601-664-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3639PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS256527Medicare ID - Type Unspecified