Provider Demographics
NPI:1255666822
Name:FUNCK, JUSTIN ALAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ALAN
Last Name:FUNCK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CRESTON DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1873
Mailing Address - Country:US
Mailing Address - Phone:717-926-9709
Mailing Address - Fax:
Practice Address - Street 1:2829 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3321
Practice Address - Country:US
Practice Address - Phone:717-431-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002553225200000X
PATE008288225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant