# GENESIS REHAB

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

## Provider details

- **NPI number:** 1225341589
- **Authorized official:** IAN FISH PT (PHYSICAL THERAPIST)
- **Authorized official phone:** (803) 446-9378

## Contact information

- **Practice address:** 731 POLO ROAD, WILDEWOOD DOWNS, COLUMBIA, SC 29223
- **Practice address phone:** (803) 446-9378
- **Mailing address:** 120 TORREYGLEN DR, LEXINGTON, SC 29072-8057
- **Mailing address phone:** (803) 463-6465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | 799 | SC | Yes |

## Other

- **Enumeration date:** 07/15/2010
- **Last updated:** 07/15/2010