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General NPI Number Information
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NPI Number | 1902179484
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Entity Type | Organization
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Legal Business Name | FUNCTION AT HOME DBA THE BODY MECHANIX
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 18414 NE GARDEN DR
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City | VANCOUVER
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State | WA
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Zip | 98682-3612
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Country | US
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Telephone | 503-810-0837
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Fax |
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Provider Business Mailing Address
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Address Line | 18414 NE GARDEN DR
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City | VANCOUVER
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State | WA
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Zip | 98682-3612
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Country | US
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Telephone | 503-810-0837
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. JENNIFER JEANNE FLENTKE
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Credential | PT
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Telephone | 503-810-0837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | WA PT 0000 9414
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License Number State | WA
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