Healthcare Provider Details

I. General information

NPI: 1154132090
Provider Name (Legal Business Name): REHABMARK THERAPY AND WELLNESS, A PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 MONTE VISTA AVE
MONTCLAIR CA
91763-2233
US

IV. Provider business mailing address

2934 E GARVEY AVE S STE 250
WEST COVINA CA
91791-2186
US

V. Phone/Fax

Practice location:
  • Phone: 909-358-1699
  • Fax:
Mailing address:
  • Phone: 909-358-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ANTHONY PALACIOS
Title or Position: CEO
Credential: PT
Phone: 909-802-5824