MEDICARE: GENIE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1205200029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENIE THERAPY

Provider Business Mailing Address
First Line	:	5680 TEQUESTA CT
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48323-2346
Country	:	US
Telephone Number	:	313-701-0744
Fax Number	:

Provider Business Practice Location Address
First Line	:	5680 TEQUESTA CT
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48323-2346
Country	:	US
Telephone Number	:	313-701-0744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DWENDE RIED
Credential	:
Telephone Number	:	313-701-0744

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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Directions to “GENIE THERAPY ” Practice Location

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