Provider Demographics
NPI:1447405964
Name:FUNCTION FOUNDATION, INC.
Entity type:Organization
Organization Name:FUNCTION FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:619-229-3909
Mailing Address - Street 1:3323 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1035
Mailing Address - Country:US
Mailing Address - Phone:858-720-0991
Mailing Address - Fax:858-720-0992
Practice Address - Street 1:3323 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1035
Practice Address - Country:US
Practice Address - Phone:858-720-0991
Practice Address - Fax:858-720-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26571225100000X
CAPT 26653225100000X
CAPT 24080225100000X
CAPT 26678225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty