Provider Demographics
NPI:1861523706
Name:GENESIS REHABILITATION, INC. DBA FYZICAL THERAPY AND BALANCE CENTER
Entity type:Organization
Organization Name:GENESIS REHABILITATION, INC. DBA FYZICAL THERAPY AND BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PTH
Authorized Official - Phone:337-289-5696
Mailing Address - Street 1:101 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4101
Mailing Address - Country:US
Mailing Address - Phone:334-289-5696
Mailing Address - Fax:334-289-5578
Practice Address - Street 1:101 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4101
Practice Address - Country:US
Practice Address - Phone:334-289-5696
Practice Address - Fax:334-289-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 3269261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556Medicare ID - Type UnspecifiedPROVIDER NUMBER
ALQ46345Medicare UPIN