Provider Demographics
NPI:1598481509
Name:FUNK, RACHEL RAE (LMT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RAE
Last Name:FUNK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 SW VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4643
Mailing Address - Country:US
Mailing Address - Phone:971-470-6014
Mailing Address - Fax:
Practice Address - Street 1:2343 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7976
Practice Address - Country:US
Practice Address - Phone:503-336-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist