Provider Demographics
NPI:1750359196
Name:FUNKEY, GLEN G (PT, DPT)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:G
Last Name:FUNKEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5632
Mailing Address - Country:US
Mailing Address - Phone:325-690-1952
Mailing Address - Fax:
Practice Address - Street 1:2500 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-5017
Practice Address - Country:US
Practice Address - Phone:325-795-3708
Practice Address - Fax:325-795-3707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist