Individual
MARYANN FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5601 SE 122ND AVE, PORTLAND, OR 97236-4601
(503) 761-3181
Mailing address
12650 SW GRANT AVE APT 4, TIGARD, OR 97223-5158
(503) 761-3181
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7182
OR
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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