Healthcare Provider Details

I. General information

NPI: 1407149164
Provider Name (Legal Business Name): OLYMPIC REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 W GLENOAKS BLVD SUITE 204
GLENDALE CA
91201-3146
US

IV. Provider business mailing address

1314 W GLENOAKS BLVD SUITE 204
GLENDALE CA
91201-3146
US

V. Phone/Fax

Practice location:
  • Phone: 818-204-8797
  • Fax:
Mailing address:
  • Phone: 818-204-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT15084
License Number StateCA

VIII. Authorized Official

Name: MR. MAREK W PIATKOWSKI-NAZARRO
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 323-204-8797