Healthcare Provider Details

I. General information

NPI: 1104036102
Provider Name (Legal Business Name): ROBERT PAUL FUNDTER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 LA CRESCENTA AVE
LA CRESCENTA CA
91214-3914
US

IV. Provider business mailing address

440 FOOTHILL BLVD
LA CANADA CA
91011-3503
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax: 818-369-7621
Mailing address:
  • Phone: 818-369-7620
  • Fax: 818-369-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: