Individual
STACEY MICHELLE FUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
31228 PALOS VERDES DR W, RANCHO PALOS VERDES, CA 90275-5361
(310) 544-7325
(310) 544-2625
Mailing address
2850 ARTESIA BLVD, STE 207, REDONDO BEACH, CA 90278-3413
(310) 371-4774
(310) 371-3453
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT29687
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT29687
PHYSICAL THERAPY LICENSE
CA
Enumeration date
06/23/2010
Last updated
05/31/2018
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