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General NPI Number Information
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NPI Number | 1225341589
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 731 POLO ROAD WILDEWOOD DOWNS
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City | COLUMBIA
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State | SC
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Zip | 29223
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Country | US
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Telephone | 803-446-9378
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Fax |
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Provider Business Mailing Address
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Address Line | 120 TORREYGLEN DR
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City | LEXINGTON
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State | SC
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Zip | 29072-8057
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Country | US
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Telephone | 803-463-6465
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | IAN FISH
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Credential | PT
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Telephone | 803-446-9378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 799
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License Number State | SC
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