Provider Demographics
NPI:1598131393
Name:FUNCTIONAL LIFE CONSULTING, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL LIFE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L, CAPS
Authorized Official - Phone:847-644-1280
Mailing Address - Street 1:3302 WEST LAKE WOODS
Mailing Address - Street 2:APARTMENT #126
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-3677
Mailing Address - Country:US
Mailing Address - Phone:847-644-1280
Mailing Address - Fax:847-440-9000
Practice Address - Street 1:3302 WEST LAKE WOODS
Practice Address - Street 2:APARTMENT #126
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-3677
Practice Address - Country:US
Practice Address - Phone:847-644-1280
Practice Address - Fax:847-440-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 261QR0400X, 261QR0401X, 310400000X
IL056010180261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility