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Organization
FUNCTION FOR LIFE PT INC
Active
Organization
FUNCTION FOR LIFE PT INC
Active
Other names
Longevity Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BLOOM DPT (CFO, OWNER)
(760) 230-2316
Entity
Organization
Contact information
Practice address
227 N EL CAMINO REAL SUITE 103, ENCINITAS, CA 92024
(760) 230-2316
(760) 230-2317
Mailing address
227 N EL CAMINO REAL SUITE 103, ENCINITAS, CA 92024
(760) 230-2316
(760) 230-2317
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
40858
CA
Other
Enumeration date
01/22/2014
Last updated
01/22/2014
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