# IMPACT DANCE AND PHYSICAL THERAPY PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861396137
- **Authorized official:** NICOLE BLAIR TAYLOE PT, DPT (CLINIC OWNER)
- **Authorized official phone:** (619) 666-2120

## Contact information

- **Practice address:** 7857 CONVOY CT, SAN DIEGO, CA 92111-1221
- **Practice address phone:** (619) 666-2120
- **Mailing address:** 7857 CONVOY CT STE 211, SAN DIEGO, CA 92111-1221
- **Mailing address phone:** (619) 666-2120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2026
- **Last updated:** 10/07/2026