Provider Demographics
NPI:1891837712
Name:ROBERT FUNK & ASSOCIATES PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ROBERT FUNK & ASSOCIATES PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-640-4881
Mailing Address - Street 1:2345 MOODY PKWY
Mailing Address - Street 2:STE 206
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3004
Mailing Address - Country:US
Mailing Address - Phone:205-640-4881
Mailing Address - Fax:205-640-4882
Practice Address - Street 1:2345 MOODY PKWY
Practice Address - Street 2:STE 206
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3004
Practice Address - Country:US
Practice Address - Phone:205-640-4881
Practice Address - Fax:205-640-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533197OtherBLUE CROSS OF AL
AL051533197Medicare ID - Type Unspecified
AL51533197OtherBLUE CROSS OF AL