Provider Demographics
NPI:1346473873
Name:GENESIS REHAB.
Entity type:Organization
Organization Name:GENESIS REHAB.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LYRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:314-469-5008
Mailing Address - Street 1:12858 STRATHEARN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3773
Mailing Address - Country:US
Mailing Address - Phone:314-469-5008
Mailing Address - Fax:
Practice Address - Street 1:12858 STRATHEARN DRIVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-469-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100097314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility