Healthcare Provider Details

I. General information

NPI: 1649468034
Provider Name (Legal Business Name): GENESIS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SE 18TH AVE BUILDING 500
OCALA FL
34471-8215
US

IV. Provider business mailing address

8792 SE 19TH AVENUE RD
OCALA FL
34480-5711
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-1474
  • Fax:
Mailing address:
  • Phone: 352-817-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT9259
License Number StateFL

VIII. Authorized Official

Name: MARSHA C. MCDANIEL
Title or Position: CO-OWNER
Credential: P.T., M.B.A.
Phone: 352-817-3896