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General NPI Number Information
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NPI Number | 1932627312
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL RD, LLC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 11107 WURZBACH RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2500
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Country | US
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Telephone | 210-920-0669
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Fax | 210-920-6645
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Provider Business Mailing Address
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Address Line | 14439 NW MILITARY HWY STE 108
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City | SHAVANO PARK
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State | TX
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Zip | 78231-1648
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Country | US
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Telephone | 210-920-0669
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Fax | 210-920-6645
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | AIMEE ELIZABETH SENIOR
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Credential | RD, LD
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Telephone | 210-920-0669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT83404
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License Number State | TX
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