MEDICARE: GENESIS REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	OTA8034	FL

General Provider Information

NPI Number	:	1144561473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS REHAB

Provider Business Mailing Address
First Line	:	4970 N KAY ST
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-6167
Country	:	US
Telephone Number	:	561-627-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	4970 N. KAY ST.
Second Line	:
City	:	PALM BCH. GARDENS
State	:	FL
Zip	:	33418
Country	:	US
Telephone Number	:	561-627-0712
Fax Number	:

Authorized Official
Title or Position	:	COTA/L
Name	:	MRS. SUSAN D. PALERMO
Credential	:
Telephone Number	:	561-310-2492

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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Directions to “GENESIS REHAB ” Practice Location

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