Provider Demographics
NPI:1235455734
Name:GENECCO REHAB INC
Entity type:Organization
Organization Name:GENECCO REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENECCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-373-6308
Mailing Address - Street 1:11134 OAK WAY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3316
Mailing Address - Country:US
Mailing Address - Phone:561-373-6308
Mailing Address - Fax:866-757-9692
Practice Address - Street 1:17380 ALT A1A
Practice Address - Street 2:SUITE 305
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5860
Practice Address - Country:US
Practice Address - Phone:561-741-1661
Practice Address - Fax:561-741-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty