Healthcare Provider Details

I. General information

NPI: 1902024334
Provider Name (Legal Business Name): GENESYS INTEGRATED GROUP PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 N CLIO RD
MOUNT MORRIS MI
48458-8261
US

IV. Provider business mailing address

7057 N CLIO RD
MOUNT MORRIS MI
48458-8261
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-2007
  • Fax: 810-743-1099
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: PAUL GARSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 810-424-2007