Provider Demographics
NPI:1639625320
Name:GENEVRO, MARCUS (DPT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:GENEVRO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:5110 S RURAL RD
Practice Address - Street 2:STE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7289
Practice Address - Country:US
Practice Address - Phone:480-629-5549
Practice Address - Fax:480-629-5493
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist