Provider Demographics
NPI:1174851984
Name:GPTRS II
Entity Type:Organization
Organization Name:GPTRS II
Other - Org Name:GENESIS PHYSICAL THERAPY AND REHABILITATION SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-898-4324
Mailing Address - Street 1:227 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4423
Mailing Address - Country:US
Mailing Address - Phone:601-898-4324
Mailing Address - Fax:601-898-4325
Practice Address - Street 1:227 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4423
Practice Address - Country:US
Practice Address - Phone:601-898-4324
Practice Address - Fax:601-898-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS410455061OtherBLUE CROSS STEGALL
MS425069689FOtherBLUE CROSS TRUSSELL