# GENESIS PHYSICAL THERAPY & WELLNESS CENTER, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215008990
- **Authorized official:** RANDAL S. RICHARDSON PT (OWNER)
- **Authorized official phone:** (937) 323-8000

## Contact information

- **Practice address:** 4230 E. NATIONAL ROAD (REAR), SPRINGFIELD, OH 45505-1714
- **Practice address phone:** (937) 323-8000
- **Practice address fax:** (937) 323-6960
- **Mailing address:** 4230 E. NATIONAL ROAD (REAR), SPRINGFIELD, OH 45505-1714
- **Mailing address phone:** (937) 323-8000
- **Mailing address fax:** (937) 323-6960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | PT006483 | OH | Yes |

## Other

- **Enumeration date:** 11/13/2006
- **Last updated:** 05/16/2008