# GENESIS PHYSICAL THERAPY LLC

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

## Provider details

- **NPI number:** 1770168767
- **Authorized official:** WAYNE HANSEN (OWNER)
- **Authorized official phone:** (801) 499-9831

## Contact information

- **Practice address:** 5500 S REDWOOD RD \# 206, TAYLORSVILLE, UT 84123-5375
- **Practice address phone:** (801) 499-9831
- **Mailing address:** 5500 S REDWOOD RD \# 206, TAYLORSVILLE, UT 84123-5375

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2021
- **Last updated:** 03/11/2021