Provider Demographics
NPI:1134793854
Name:FUNDERBURK, AMY JO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:AMY JO
Middle Name:
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 RUSHFORD DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3087
Mailing Address - Country:US
Mailing Address - Phone:716-946-0956
Mailing Address - Fax:
Practice Address - Street 1:4414 RUSHFORD DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3087
Practice Address - Country:US
Practice Address - Phone:716-946-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist