Provider Demographics
NPI:1194144592
Name:FUNCPHYSIO PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:FUNCPHYSIO PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOHEI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-512-1827
Mailing Address - Street 1:2 WEST 45TH STREET
Mailing Address - Street 2:SUITE1600
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4229
Mailing Address - Country:US
Mailing Address - Phone:917-388-2031
Mailing Address - Fax:646-661-2358
Practice Address - Street 1:2 WEST 45TH STREET
Practice Address - Street 2:SUITE1600
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4229
Practice Address - Country:US
Practice Address - Phone:917-388-2031
Practice Address - Fax:646-661-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030680261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy