# FUNWORKS PEDIATRIC THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275984114
- **Authorized official:** SHAWNA LEA MCCORMICK PT (OWNER/ PHYSICAL THERAPIST)
- **Authorized official phone:** (910) 689-5071

## Contact information

- **Practice address:** 408 WASHINGTON ST, SOUTH POINT, OH 45680-9660
- **Practice address phone:** (910) 689-5071
- **Practice address fax:** (888) 398-8146
- **Mailing address:** PO BOX 22, MINFORD, OH 45653-0022
- **Mailing address phone:** (910) 689-5071
- **Mailing address fax:** (888) 398-8146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 003960 | KY | Yes |

## Other

- **Enumeration date:** 06/22/2016
- **Last updated:** 06/19/2020