Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1033647847 |
---|---|
Provider Name | Sarah Elizabeth Funderburg |
First Address | Greenville, SC 29607-6122 |
Second Address | Greenville, SC 29605-4210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 17/03/2018 |