Provider Demographics
NPI:1326133158
Name:FUNCTIONAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:FUNCTIONAL SOLUTIONS, INC.
Other - Org Name:DYNAMIC PHYSICAL & OCCUPATION THERAPIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:DY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:615-429-1631
Mailing Address - Street 1:102 FIELDCREST CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7082
Mailing Address - Country:US
Mailing Address - Phone:615-429-1631
Mailing Address - Fax:615-824-5971
Practice Address - Street 1:102 FIELDCREST CIR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7082
Practice Address - Country:US
Practice Address - Phone:615-429-1631
Practice Address - Fax:615-824-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727928Medicare PIN
TN3727928Medicare UPIN