Provider Demographics
NPI:1033080890
Name:FUNKTIONAL PHYSIOTHERAPY PC
Entity type:Organization
Organization Name:FUNKTIONAL PHYSIOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:FUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:216-375-1120
Mailing Address - Street 1:1013 W KENSINGTON RD APT 3/4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4353
Mailing Address - Country:US
Mailing Address - Phone:216-375-1120
Mailing Address - Fax:
Practice Address - Street 1:1013 W KENSINGTON RD APT 3/4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4353
Practice Address - Country:US
Practice Address - Phone:216-375-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty