Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | NC |
NPI | 1679167787 |
---|---|
Provider Name | Kiondra Funderburk |
First Address | Durham, NC 27704-4984 |
Second Address | Durham, NC 27704-4984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |