Healthcare Provider Details

I. General information

NPI: 1356469225
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WOOD ST
SISTERSVILLE WV
26175
US

IV. Provider business mailing address

149 FIRST STREET
POWHATAN OH
43942
US

V. Phone/Fax

Practice location:
  • Phone: 304-652-1032
  • Fax:
Mailing address:
  • Phone: 740-795-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001962
License Number StateWV

VIII. Authorized Official

Name: JAMES CHRISTOPHER WISVARI
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 740-795-5492