Basic Information
| Provider Information | |||||||||
| NPI: | 1598043309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GPTRS II | ||||||||
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| OtherOrganizationName: | GENESIS PHYSICAL THERAPY AND REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 HIGHLAND WAY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MADISON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391106929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017909446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 CORPORATE DR | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391578803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018987527 | ||||||||
| FaxNumber: | 6018987577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 07/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6018984324 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.