Healthcare Provider Details

I. General information

NPI: 1780131151
Provider Name (Legal Business Name): JAEL FUNTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WESTMINSTER PL
GROVE CITY PA
16127-6377
US

IV. Provider business mailing address

39 WESTMINSTER PL
GROVE CITY PA
16127-6377
US

V. Phone/Fax

Practice location:
  • Phone: 814-813-1279
  • Fax:
Mailing address:
  • Phone: 814-813-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: