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General NPI Number Information
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NPI Number | 1427060367
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH GROUP
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 4405 W RIVERSIDE DR SUITE 205
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City | BURBANK
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State | CA
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Zip | 91505-4072
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Country | US
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Telephone | 818-754-1124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2101
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City | TOLUCA LAKE
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State | CA
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Zip | 91610-0101
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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 | D.C.
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Name | DR. V K MISHRA
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Credential | D.C.
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Telephone | 818-754-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19993
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License Number State | CA
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