Healthcare Provider Details

I. General information

NPI: 1972874139
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 OAKFIELD DR
BRANDON FL
33511-4854
US

IV. Provider business mailing address

911 KNIGHT ST
SEFFNER FL
33584-3928
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT14842
License Number StateFL

VIII. Authorized Official

Name: ERIC GRECCO
Title or Position: OCCUPATIONAL THERAPIST REGISTERED
Credential:
Phone: 813-293-1456