Provider Demographics
NPI:1568680999
Name:GENESYS INTEGRATED GROUP PRACTICE PC
Entity Type:Organization
Organization Name:GENESYS INTEGRATED GROUP PRACTICE PC
Other - Org Name:PHYSICIANS INTEGRATED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-424-2136
Mailing Address - Street 1:1096 S BELSAY RD
Mailing Address - Street 2:STE G
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1948
Mailing Address - Country:US
Mailing Address - Phone:810-743-1611
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:1096 S BELSAY RD
Practice Address - Street 2:STE G
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-743-1611
Practice Address - Fax:810-743-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01012461OtherHEALTHPLUS OF MICHIGAN
MI01012461OtherHEALTHPLUS OF MICHIGAN