Healthcare Provider Details

I. General information

NPI: 1740922905
Provider Name (Legal Business Name): REHABMARK THERAPY AND WELLNESS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 E GARVEY AVE S STE 250
WEST COVINA CA
91791-2186
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: 909-802-5824
  • Fax:
Mailing address:
  • Phone: 909-802-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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