Provider Demographics
NPI:1407291438
Name:FUNKE, HELEN (PT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:FUNKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:MAZZARESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1048 PEPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6794
Mailing Address - Country:US
Mailing Address - Phone:810-986-5816
Mailing Address - Fax:
Practice Address - Street 1:1048 PEPPERWOOD CT
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6794
Practice Address - Country:US
Practice Address - Phone:810-986-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist