=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386982643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS REHAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2013
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7716 W MANCHESTER AVE
-----------------------------------------------------
City | PLAYA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90293-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-823-4694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8106 FORDHAM RD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | ISABELLA SAUTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-649-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 19031
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------