| Organization Name: | GENESIS PHYSICAL THERAPY & REHABILITATION LLC |
| NPI Number: | 1134135833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLARENCE WAYNE WHITLEY (C.O.O.) |
| Mailing Address: | 290 E Layfair Dr Suite B Flowood |
| State: | MS US |
| Postal Code: | 392329526 |
| Phone Number: | 6019831200 |
| Fax Number: | 6019831205 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |