Healthcare Provider Details

I. General information

NPI: 1396396792
Provider Name (Legal Business Name): GENESIS 2 NATURALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 E SILVER STAR RD STE 121
OCOEE FL
34761-7014
US

IV. Provider business mailing address

1746 E SILVER STAR RD STE 121
OCOEE FL
34761-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-832-5066
  • Fax:
Mailing address:
  • Phone: 407-832-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: AUDREY PERRYMAN PERRYMAN
Title or Position: OWNER
Credential:
Phone: 407-832-5066