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General NPI Number Information
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NPI Number | 1124337142
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Entity Type | Organization
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Legal Business Name | GENESIS REHABILITATION SERVICES
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 7927 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34667-6783
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Country | US
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Telephone | 727-378-8586
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Fax | 727-378-8587
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Provider Business Mailing Address
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Address Line | 7927 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34667-6783
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Country | US
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Telephone | 727-378-8586
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Fax | 727-378-8587
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Authorized Official
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Title or Position | PHYSICAL THERAPY ASSISTANT
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Name | MRS. ELIZABETH JEAN LIGHTLE
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Credential | P.T.A.
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Telephone | 727-375-1745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 18917
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License Number State | FL
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