NPIMap

Organization Active NPI

Genesis Rehabilitation, Inc. Dba Fyzical Therapy and Balance Center

  • Physical Therapy Clinic/Center
  • Demopolis, AL
National Provider Identifier
1861523706
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PTH 3269 Issued in AL
Legal business name
GENESIS REHABILITATION, INC. DBA FYZICAL THERAPY AND BALANCE CENTER
Practice address
101 US Highway 80 W
Demopolis, AL 36732-4101
Phone
(334) 289-5696
Fax
(334) 289-5578
NPI assigned
Mar 9, 2007
Last updated
Mar 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Authorized official

Name
Mr. William J Holman, PTHNPI 1639182108
Title
President
Phone
(337) 289-5696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PTH 3269 AL Primary

Addresses

Primary practice location

101 US Highway 80 W
Demopolis, AL 36732-4101

Mailing address

101 US Highway 80 W
Demopolis, AL 36732-4101
Phone (334) 289-5696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050629000229 AL Part B Supplier - Clinic/Group Practice 7719923804 Receives reassigned benefits from 2 practitioners
Practice locations: Demopolis, AL

National Provider Directory

National Provider Directory
Tax ID family
Genesis Rehabilitation Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

101 US Highway 80 W
Demopolis, AL 36732
Phone (334) 289-5696

1351 US Highway 80 W
Demopolis, AL 36732
Phone (334) 289-5696

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583452800000",
    "number": "1861523706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 US HIGHWAY 80 W",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367324101",
            "telephone_number": "334-289-5696",
            "fax_number": "334-289-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 US HIGHWAY 80 W",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367324101",
            "telephone_number": "334-289-5696",
            "fax_number": "334-289-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS REHABILITATION, INC. DBA FYZICAL THERAPY AND BALANCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "HOLMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-289-5696",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PTH"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AL",
            "license": "PTH 3269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Demopolis, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.