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General NPI Number Information
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NPI Number | 1255561759
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Entity Type | Organization
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Legal Business Name | GENESIS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 9150 E 109TH AVE. SUITE 1A
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City | CROWN POINT
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State | IN
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Zip | 46307
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Country | US
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Telephone | 219-310-8584
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Fax | 219-310-8685
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Provider Business Mailing Address
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Address Line | 9150 E 109TH AVE. SUITE 1A
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City | CROWN POINT
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State | IN
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Zip | 46307
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Country | US
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Telephone | 219-310-8584
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Fax | 219-310-8685
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Authorized Official
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Title or Position | CLINIC OPERATIONS DIRECTOR
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Name | MR. MICHAEL ROBERT SLAGER
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Credential | LPN
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Telephone | 219-310-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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