Provider Demographics
NPI:1134904170
Name:FUNCTIONPRO REHAB SERVICES LLC
Entity type:Organization
Organization Name:FUNCTIONPRO REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-696-1396
Mailing Address - Street 1:31 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4403
Mailing Address - Country:US
Mailing Address - Phone:201-696-1396
Mailing Address - Fax:
Practice Address - Street 1:31 LAUREL DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4403
Practice Address - Country:US
Practice Address - Phone:201-696-1396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation