Healthcare Provider Details

I. General information

NPI: 1437572724
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NW 95TH ST
MIAMI FL
33150-2032
US

IV. Provider business mailing address

1321 WHITE STONE WAY
DAVIE FL
33325-3065
US

V. Phone/Fax

Practice location:
  • Phone: 305-853-5848
  • Fax:
Mailing address:
  • Phone: 954-612-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA20862
License Number StateFL

VIII. Authorized Official

Name: MRS. DEBRA L LARUE
Title or Position: PHYSICAL THERAPIST ASST
Credential: PTA
Phone: 954-612-1389