Individual
MRS. DIANE BRACKEN FUNDERBURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
437 E CAMBRIDGE AVE, GREENWOOD, SC 29646-2244
(864) 330-3000
(864) 388-7318
Mailing address
804 ROCK HOUSE RD, GREENWOOD, SC 29646-7627
(864) 993-4777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
913
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH0631
—
SC
Enumeration date
09/13/2006
Last updated
07/17/2015
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