Healthcare Provider Details

I. General information

NPI: 1245419829
Provider Name (Legal Business Name): WELLNESS P.T. & REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N GLENDALE AVE STE 2
GLENDALE CA
91206-2157
US

IV. Provider business mailing address

1010 N GLENDALE AVE STE 2
GLENDALE CA
91206-2157
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-0049
  • Fax: 818-240-0046
Mailing address:
  • Phone: 818-240-0049
  • Fax: 818-240-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number27153
License Number StateCA

VIII. Authorized Official

Name: MARINA MELKONOVA
Title or Position: CEO
Credential: P.T.
Phone: 818-749-8557