Provider Demographics
NPI:1831329606
Name:FUNG, REBECCA SANDERS (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SANDERS
Last Name:FUNG
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KATHRYN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS
Mailing Address - Street 1:3825 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3324
Mailing Address - Country:US
Mailing Address - Phone:650-565-8090
Mailing Address - Fax:
Practice Address - Street 1:3825 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3324
Practice Address - Country:US
Practice Address - Phone:650-565-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009650225100000X
CA430472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist