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General NPI Number Information
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NPI Number | 1407347586
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL DME
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 930B PRAYER HOUSE RD
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City | WASHINGTON
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State | LA
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Zip | 70589-9113
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Country | US
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Telephone | 225-412-9955
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Fax | 225-412-9957
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Provider Business Mailing Address
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Address Line | PO BOX 1772
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City | OPELOUSAS
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State | LA
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Zip | 70571-1772
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Country | US
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Telephone | 225-412-9955
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Fax | 225-412-9957
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN RYAN
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Credential |
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Telephone | 225-412-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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