Provider Demographics
NPI:1144680463
Name:FUNKE, ERICH NATHAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:NATHAN
Last Name:FUNKE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9166
Mailing Address - Country:US
Mailing Address - Phone:330-659-4050
Mailing Address - Fax:
Practice Address - Street 1:3807 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9166
Practice Address - Country:US
Practice Address - Phone:330-659-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist