Provider Demographics
NPI:1225324734
Name:FUNCTIONAL ADVANTAGE, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:989-714-3183
Mailing Address - Street 1:5866 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8707
Mailing Address - Country:US
Mailing Address - Phone:989-573-8588
Mailing Address - Fax:989-573-8589
Practice Address - Street 1:5866 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8707
Practice Address - Country:US
Practice Address - Phone:989-579-8588
Practice Address - Fax:989-573-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty