Provider Demographics
NPI:1649433038
Name:FUNK, CHARLES M (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:FUNK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 CORALBEAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2894
Mailing Address - Country:US
Mailing Address - Phone:941-918-9575
Mailing Address - Fax:941-346-9646
Practice Address - Street 1:9122 TOWN CENTER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5050
Practice Address - Country:US
Practice Address - Phone:941-373-3910
Practice Address - Fax:941-346-9646
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist