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General NPI Number Information
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NPI Number | 1609143213
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Entity Type | Individual
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Provider Name | KELLI FUNKHOUSER MS, PT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2011
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 4194 INNSLAKE DR
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3344
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Country | US
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Telephone | 804-217-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 371 SILVER OAKS DR
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City | HARRISONBURG
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State | VA
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Zip | 22801-3578
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT26509
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305207303
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License Number State | VA
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