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General NPI Number Information
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NPI Number | 1174262315
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Entity Type | Individual
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Provider Name | JULIA KAY GENOVESI AT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 1025 RISMAN DRIVE
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City | KENT
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State | OH
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Zip | 44242-0001
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Country | US
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Telephone | 330-672-8439
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 WINSHALL DR
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-1110
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Country | US
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Telephone | 810-513-2222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601002708
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 006585
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License Number State | OH
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