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General NPI Number Information
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NPI Number | 1821309006
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Entity Type | Individual
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Provider Name | STACEY MICHELLE FUNK P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 31228 PALOS VERDES DR W
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-5361
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Country | US
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Telephone | 310-544-7325
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Fax | 310-544-2625
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Provider Business Mailing Address
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Address Line | 2850 ARTESIA BLVD STE 207
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3413
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Country | US
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Telephone | 310-371-4774
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Fax | 310-371-3453
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT29687
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License Number State | CA
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