Provider Demographics
NPI:1255561759
Name:GENESIS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:GENESIS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:219-310-8584
Mailing Address - Street 1:9150 E 109TH AVE.
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-310-8584
Mailing Address - Fax:219-310-8685
Practice Address - Street 1:9150 E 109TH AVE.
Practice Address - Street 2:SUITE 1A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-310-8584
Practice Address - Fax:219-310-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy