Provider Demographics
NPI:1083030050
Name:GENESIS REHABILITATION
Entity Type:Organization
Organization Name:GENESIS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:WERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-215-6606
Mailing Address - Street 1:171 WERTZ DR
Mailing Address - Street 2:
Mailing Address - City:DYSART
Mailing Address - State:PA
Mailing Address - Zip Code:16636-9216
Mailing Address - Country:US
Mailing Address - Phone:814-215-6606
Mailing Address - Fax:
Practice Address - Street 1:37 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1857
Practice Address - Country:US
Practice Address - Phone:570-724-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility