Healthcare Provider Details

I. General information

NPI: 1306118021
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 877-221-9349
  • Fax:
Mailing address:
  • Phone: 877-221-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPTA00756
License Number StateRI

VIII. Authorized Official

Name: MS. STACY LYNN AARON
Title or Position: PTA
Credential:
Phone: 14016547019