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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