Provider Demographics
NPI:1972844140
Name:FUNCTION FIT REHAB
Entity Type:Organization
Organization Name:FUNCTION FIT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, DC
Authorized Official - Phone:858-202-1546
Mailing Address - Street 1:5348 CARROLL CANYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1733
Mailing Address - Country:US
Mailing Address - Phone:858-202-1546
Mailing Address - Fax:858-202-1548
Practice Address - Street 1:5348 CARROLL CANYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1733
Practice Address - Country:US
Practice Address - Phone:858-202-1546
Practice Address - Fax:858-202-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8848174H00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty