MEDICARE: FUNKTIONAL PHYSIOTHERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1033080890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNKTIONAL PHYSIOTHERAPY PC

Provider Business Mailing Address
First Line	:	1013 W KENSINGTON RD APT 3/4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4353
Country	:	US
Telephone Number	:	216-375-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 W KENSINGTON RD APT 3/4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4353
Country	:	US
Telephone Number	:	216-375-1120
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/PRESIDENT
Name	:	MR. ERICH NATHAN FUNKE
Credential	:	PT, DPT
Telephone Number	:	216-375-1120

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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