Provider Demographics
NPI:1821371386
Name:GENESIS THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:GENESIS THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MA
Authorized Official - Phone:956-627-0108
Mailing Address - Street 1:4325 N 23RD ST
Mailing Address - Street 2:STE A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4166
Mailing Address - Country:US
Mailing Address - Phone:956-627-0108
Mailing Address - Fax:956-627-0110
Practice Address - Street 1:4325 N 23RD ST
Practice Address - Street 2:STE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4166
Practice Address - Country:US
Practice Address - Phone:956-627-0108
Practice Address - Fax:956-627-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143939003Medicaid
TX219990301Medicaid