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General NPI Number Information
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NPI Number | 1245419829
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Entity Type | Organization
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Legal Business Name | WELLNESS P.T. & REHAB, INC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 1010 N GLENDALE AVE STE 2
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City | GLENDALE
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State | CA
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Zip | 91206-2157
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Country | US
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Telephone | 818-240-0049
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Fax | 818-240-0046
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Provider Business Mailing Address
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Address Line | 1010 N GLENDALE AVE STE 2
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City | GLENDALE
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State | CA
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Zip | 91206-2157
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Country | US
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Telephone | 818-240-0049
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Fax | 818-240-0046
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Authorized Official
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Title or Position | CEO
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Name | MARINA MELKONOVA
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Credential | P.T.
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Telephone | 818-749-8557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 27153
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License Number State | CA
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