Provider Demographics
NPI:1811033640
Name:RAILEY-FUNARO, JUDI (LMP)
Entity Type:Individual
Prefix:MS
First Name:JUDI
Middle Name:
Last Name:RAILEY-FUNARO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4087
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4087
Mailing Address - Country:US
Mailing Address - Phone:360-670-3004
Mailing Address - Fax:
Practice Address - Street 1:127 W BELL ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3752
Practice Address - Country:US
Practice Address - Phone:360-582-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist