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General NPI Number Information
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NPI Number | 1649468034
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB, LLC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 1901 SE 18TH AVE BUILDING 500
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City | OCALA
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State | FL
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Zip | 34471-8215
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Country | US
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Telephone | 352-351-1474
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Fax |
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Provider Business Mailing Address
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Address Line | 8792 SE 19TH AVENUE RD
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City | OCALA
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State | FL
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Zip | 34480-5711
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Country | US
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Telephone | 352-817-3896
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARSHA C. MCDANIEL
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Credential | P.T., M.B.A.
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Telephone | 352-817-3896
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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 | PT9259
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License Number State | FL
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