Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 880 | MS |
NPI | 1396843488 |
---|---|
Provider Name | Mr. Ralph Richard Funk Ii |
First Address | Largo, FL 33773-4115 |
Second Address | Bay Pines, FL 33744-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |