MEDICARE: CHARLES FUNK DPT

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	225100000X	Physical Therapist	2990	NE

General Provider Information

NPI Number	:	1790127165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FUNK DPT

Provider Business Mailing Address
First Line	:	811 E 14TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1216
Country	:	US
Telephone Number	:	402-375-1922
Fax Number	:	402-375-1923

Provider Business Practice Location Address
First Line	:	811 E 14TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1216
Country	:	US
Telephone Number	:	402-375-1922
Fax Number	:	402-375-1923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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Directions to “ CHARLES FUNK DPT” Practice Location

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