Provider Demographics
NPI:1528603891
Name:FUNK, PAUL ERNEST
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ERNEST
Last Name:FUNK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1415
Mailing Address - Country:US
Mailing Address - Phone:218-237-3052
Mailing Address - Fax:218-237-3055
Practice Address - Street 1:110 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1415
Practice Address - Country:US
Practice Address - Phone:218-237-3052
Practice Address - Fax:218-237-3055
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist