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General NPI Number Information
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NPI Number | 1215600838
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Entity Type | Organization
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Legal Business Name | FUNXIONAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 3000 KINGMAN ST STE 210
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City | METAIRIE
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State | LA
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Zip | 70006-6633
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Country | US
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Telephone | 985-438-7318
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 BURDETTE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70118-4106
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Country | US
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Telephone | 985-438-7318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE GAUBERT
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Credential | DPT
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Telephone | 985-438-7318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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