MEDICARE: GENESIS

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	320700000X	Physical Disabilities Residential Treatment Facility	4768	NC

General Provider Information

NPI Number	:	1336273945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS

Provider Business Mailing Address
First Line	:	419 SPRING ST
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-4635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 RIDGE CREST LN
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-2483
Country	:	US
Telephone Number	:	336-786-9132
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MARVIN B KAYE
Credential	:	LPT
Telephone Number	:	336-789-5542

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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Directions to “GENESIS ” Practice Location

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