Healthcare Provider Details

I. General information

NPI: 1578804894
Provider Name (Legal Business Name): POLFIT WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
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 WOODLAND DR
ANAHEIM CA
92801-2608
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-1293
  • Fax: 714-527-7354
Mailing address:
  • Phone: 714-828-1293
  • Fax: 714-527-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39244
License Number StateCA

VIII. Authorized Official

Name: MAGDALENA A BIALAS
Title or Position: VICE PRESIDENT
Credential: PT
Phone: 714-828-1293