Provider Demographics
NPI:1972979243
Name:FUNK, VERONICA J
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:J
Last Name:FUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:J
Other - Last Name:MIELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2956
Mailing Address - Country:US
Mailing Address - Phone:509-209-9488
Mailing Address - Fax:509-209-9489
Practice Address - Street 1:915 COMMONWEALTH AVE REAR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1394
Practice Address - Country:US
Practice Address - Phone:617-358-3700
Practice Address - Fax:617-358-3710
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61143441225100000X
MA21914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist