Individual
IDA MARIELKE FUNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5028
Mailing address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5028
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
02851
OR
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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