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General NPI Number Information
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NPI Number | 1790800894
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Entity Type | Organization
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Legal Business Name | GENESIS PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1707 WEST 20TH STREET
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City | LAUREL
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State | MS
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Zip | 39442
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Country | US
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Telephone | 601-428-2004
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Fax | 601-428-8833
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Provider Business Mailing Address
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Address Line | 1707 WEST 20TH STREET
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City | LAUREL
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State | MS
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Zip | 39442
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Country | US
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Telephone | 601-428-2004
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Fax | 601-428-8833
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTY HOLIFIELD
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Credential |
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Telephone | 601-428-2004
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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 | PT0780
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License Number State | MS
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