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General NPI Number Information
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NPI Number | 1205150802
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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 | 03/25/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 9000 TWIN SILO DR
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City | BLUE BELL
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State | PA
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Zip | 19422-4202
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Country | US
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Telephone | 215-699-8727
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E STATE ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST, CF
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Name | BRIANNE WILSON
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Credential |
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Telephone | 559-907-0215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 390200000X
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License Number State | PA
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