# GENESIS PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1790800894
- **Authorized official:** CHRISTY HOLIFIELD (OFFICE MANAGER)
- **Authorized official phone:** (601) 428-2004

## Contact information

- **Practice address:** 1707 WEST 20TH STREET, LAUREL, MS 39442
- **Practice address phone:** (601) 428-2004
- **Practice address fax:** (601) 428-8833
- **Mailing address:** 1707 WEST 20TH STREET, LAUREL, MS 39442
- **Mailing address phone:** (601) 428-2004
- **Mailing address fax:** (601) 428-8833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT0780 | MS | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 08/22/2020