Provider Demographics
NPI:1588027130
Name:GENESIS
Entity Type:Organization
Organization Name:GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:937-876-5197
Mailing Address - Street 1:2266 BIERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9039
Mailing Address - Country:US
Mailing Address - Phone:740-701-8308
Mailing Address - Fax:
Practice Address - Street 1:2266 BIERS RUN RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9039
Practice Address - Country:US
Practice Address - Phone:740-701-8308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-8384283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital