Basic Information
| Provider Information | |||||||||
| NPI: | 1578012340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS REHAB SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
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| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254560 | ||||||||
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| Practice Location | |||||||||
| Address1: | 462 MAIN ST | ||||||||
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| City: | AGAWAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010011833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2016 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | VERTULLO | ||||||||
| AuthorizedOfficialFirstName: | LINDSAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6109254560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.