Provider Demographics
NPI:1639574189
Name:FUNCTIONAL CAPACITY INTERVENTIONS
Entity Type:Organization
Organization Name:FUNCTIONAL CAPACITY INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:IANNAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-363-2324
Mailing Address - Street 1:5353 MISSION CENTER RD
Mailing Address - Street 2:120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1306
Mailing Address - Country:US
Mailing Address - Phone:619-363-2324
Mailing Address - Fax:619-719-5525
Practice Address - Street 1:4947 TWAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4217
Practice Address - Country:US
Practice Address - Phone:619-363-2324
Practice Address - Fax:619-719-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28858261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy