Provider Demographics
NPI:1225662299
Name:FUNCTIONAL EMBODIMENT PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:FUNCTIONAL EMBODIMENT PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUMAGAI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:763-245-0233
Mailing Address - Street 1:12887 CAMINITO DEL CANTO
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3758
Mailing Address - Country:US
Mailing Address - Phone:763-245-0233
Mailing Address - Fax:
Practice Address - Street 1:12887 CAMINITO DEL CANTO
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3758
Practice Address - Country:US
Practice Address - Phone:763-245-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy