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General NPI Number Information
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NPI Number | 1639574189
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL CAPACITY INTERVENTIONS
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 198 W MAIN ST
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City | EL CAJON
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State | CA
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Zip | 92020-3399
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Country | US
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Telephone | 619-444-6113
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Fax | 619-719-5525
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Provider Business Mailing Address
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Address Line | 1201 AVOCADO AVE PMB 189
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City | EL CAJON
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State | CA
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Zip | 92020-7704
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Country | US
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Telephone | 619-444-6113
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Fax | 619-719-5525
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Authorized Official
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Title or Position | PRINCIPAL MEMBER
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Name | MR. ADAM SCOTT IANNAZZO
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Credential | PT
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Telephone | 619-363-2324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 28858
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License Number State | CA
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