Organization
GENESIS REHAB
Active
Other names
Genesis Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MIRONCHENKO (PHYSICAL THERAPIST ASSISTANT)
(608) 345-3837
Entity
Organization
Contact information
Practice address
1691 YALE PL, ROCKVILLE, MD 20850-1115
(608) 345-3837
Mailing address
1691 YALE PL, ROCKVILLE, MD 20850-1115
(608) 345-3837
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
A3840
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1590869
1590869
WI
Enumeration date
02/27/2015
Last updated
02/27/2015
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