Individual
MS. ROBERTA TIERNEY FUNKHOUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
12185 CLIPPER DR, WOODBRIDGE, VA 22192-2236
(703) 496-3486
(703) 496-3487
Mailing address
6339 EMBER CT, MANASSAS, VA 20112-4030
(703) 680-6642
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306000205
VA
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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