Healthcare Provider Details

I. General information

NPI: 1497002547
Provider Name (Legal Business Name): MAGDALENA BIALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 W WOODLAND DR
ANAHEIM CA
92801-2608
US

IV. Provider business mailing address

2563 W WOODLNAD DR
ANAHEIM CA
92801-2608
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-1293
  • Fax:
Mailing address:
  • Phone: 714-828-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39244
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number39244
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number39244
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number39244
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number39244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: