Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT3419 | OH |
NPI | 1003019993 |
---|---|
Provider Name | Thomas Funke |
First Address | Perrysburg, OH 43551-1074 |
Second Address | North Canton, OH 44720-7137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |