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General NPI Number Information
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NPI Number | 1689779183
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Entity Type | Individual
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Provider Name | DIANE BRACKEN FUNDERBURK DPT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 437 E CAMBRIDGE AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-2244
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Country | US
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Telephone | 864-330-3000
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Fax | 864-388-7318
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Provider Business Mailing Address
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Address Line | 804 ROCK HOUSE RD
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City | GREENWOOD
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State | SC
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Zip | 29646-7627
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Country | US
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Telephone | 864-993-4777
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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 | 913
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License Number State | SC
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