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General NPI Number Information
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NPI Number | 1023998176
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Entity Type | Organization
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Legal Business Name | FUNKXN LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 710 NE HOLLADAY ST STE 150
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City | PORTLAND
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State | OR
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Zip | 97232-2168
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Country | US
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Telephone | 503-542-2744
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Fax | 877-773-0291
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Provider Business Mailing Address
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Address Line | 710 NE HOLLADAY ST STE 150
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City | PORTLAND
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State | OR
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Zip | 97232-2168
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Country | US
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Telephone | 503-542-2744
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Fax | 877-773-0291
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | LUCRETIA COTTON
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Credential |
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Telephone | 503-208-6096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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