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Organization
GENESIS PHYSICAL THERAPY, LLC
Active
Organization
GENESIS PHYSICAL THERAPY, LLC
Active
Other names
Mesa Health Improvement Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. N. DOUGLAS ANDERSON (PRESIDENT)
(480) 325-8838
Entity
Organization
Contact information
Practice address
6343 E MAIN ST, SUITE 8, MESA, AZ 85205-8954
(480) 325-8838
(480) 325-9191
Mailing address
6343 E MAIN ST, SUITE 8, MESA, AZ 85205-8954
(480) 325-8838
(480) 325-9191
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
OTC4110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200152
—
AZ
05
—
698269
—
AZ
Enumeration date
11/09/2006
Last updated
10/20/2009
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