Provider Demographics
NPI:1316157670
Name:FUNDERBURK, ERICA LYNN (MT-BC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LYNN
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:MT-BC
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Other - Credentials:
Mailing Address - Street 1:1300 W WARNER RD
Mailing Address - Street 2:APT 1058
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7024
Mailing Address - Country:US
Mailing Address - Phone:480-285-9275
Mailing Address - Fax:
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:STE 1000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-840-6410
Practice Address - Fax:602-840-6431
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist