Healthcare Provider Details

I. General information

NPI: 1245045947
Provider Name (Legal Business Name): FUNCTIONAL IMPACT PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 WILLOWOOD LN
ENCINITAS CA
92024-3132
US

IV. Provider business mailing address

2049 WILLOWOOD LN
ENCINITAS CA
92024-3132
US

V. Phone/Fax

Practice location:
  • Phone: 818-723-8997
  • Fax:
Mailing address:
  • Phone: 818-723-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AUBREE SMITHEY
Title or Position: OWNER
Credential: PT, DPT
Phone: 818-723-8997