Provider Demographics
NPI:1396843488
Name:FUNK II, RALPH RICHARD (KINESIOTHERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:RICHARD
Last Name:FUNK II
Suffix:
Gender:M
Credentials:KINESIOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:10322 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4115
Mailing Address - Country:US
Mailing Address - Phone:727-398-4504
Mailing Address - Fax:
Practice Address - Street 1:BAY PINES VETERANS ADMINISTRATION HEALTHCARE SYSYTEM
Practice Address - Street 2:10,000 BAY PINES BLVD
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-5005
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9440
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS880226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist