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General NPI Number Information
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NPI Number | 1053780106
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB SERVICES
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 146 COUNTY ROAD 5720
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City | CASTROVILLE
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State | TX
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Zip | 78009-2104
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Country | US
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Telephone | 210-753-5779
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Fax |
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Provider Business Mailing Address
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Address Line | 146 COUNTY ROAD 5720
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City | CASTROVILLE
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State | TX
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Zip | 78009-2104
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Country | US
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Telephone | 210-753-5779
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MR. SEAN GREGORY WEAVER
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Credential | PTA
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Telephone | 210-753-5779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 2031490
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License Number State | TX
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