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General NPI Number Information
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NPI Number | 1265768865
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Entity Type | Organization
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Legal Business Name | GENSIS REHAB SERVICES
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 10100 HILLVIEW DR
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City | PENSACOLA
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State | FL
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Zip | 32514-5436
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Country | US
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Telephone | 850-478-5153
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Fax | 850-478-5152
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Provider Business Mailing Address
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Address Line | 10100 HILLVIEW DR
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City | PENSACOLA
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State | FL
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Zip | 32514-5436
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Country | US
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Telephone | 850-478-5153
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Fax | 850-478-5152
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. STANFORD SPENCER
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Credential | OTR
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Telephone | 850-207-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT11029
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License Number State | FL
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