Genesis Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

GENESIS PHYSICAL THERAPY LLC

Practice address

2900 Foxfield Rd Ste 102
St Charles, IL 60174-5799

Phone

(630) 377-1188

Fax

(630) 377-7360

NPI assigned

Oct 17, 2023

Organization subpart

Yes

Parent organization

GENESIS ORTHOPEDICS & SPORTS MEDICINE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Andrew Shadid

Title

Ceo

Phone

(630) 377-1188

Specialties & licenses 2

Addresses

Part of

Community Orthopedics

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Genesis Orthopedics & Sports Medicine LLC

  • Orthopaedic Surgery Physician
  • St Charles, IL
  • NPI 1346389061
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hythem P Shadid, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • St Charles, IL
  • NPI 1477567394
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1699557447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD STE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD STE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "SHADID",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-377-1188",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Gazdziak, RPH
• Heather Gearen, FNP LICENSE PENDING
• Nicole Lucia Gedraitis, MHS,CCC-SLP/L
• Bradley Gee, LCPC
• Genesis Orthopedics & Sports Medicine LLC
• Genesis Rehab Services
• Mary C Gensler, D.C.
• Scott Jeffrey Genutis, DDS,MS
• Ruth George
• Sophia George, LPC

• Physical Therapy Clinic/Center in St Charles, IL
• Providers in St Charles, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.