Healthcare Provider Details

I. General information

NPI: 1922717875
Provider Name (Legal Business Name): GENESIS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLYDE RD STE 101
SOMERSET NJ
08873-3493
US

IV. Provider business mailing address

1025 SCHMIDT LN
NORTH BRUNSWICK NJ
08902-1355
US

V. Phone/Fax

Practice location:
  • Phone: 908-208-4104
  • Fax:
Mailing address:
  • Phone: 908-208-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REGAN P CHRISTIE
Title or Position: REHAB DIRECTOR
Credential: RPT
Phone: 908-208-4104