Provider Demographics
NPI:1518132901
Name:FUNCTIONSMART
Entity Type:Organization
Organization Name:FUNCTIONSMART
Other - Org Name:UNIVERSITY CITY PHYSICAL THERAPY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CINCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-452-0282
Mailing Address - Street 1:5190 GOVERNOR DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5190 GOVERNOR DR STE 107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2848
Practice Address - Country:US
Practice Address - Phone:858-452-0282
Practice Address - Fax:858-452-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA 163AMedicare UPIN