Individual provider Active NPI

Brian Funk, PTA/RD

  • Physical Therapy Assistant
  • Raleigh, NC
National Provider Identifier
1083009443
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
A5480 Issued in NC
Practice address
3001 Edwards Mill Rd
Raleigh, NC 27612-5243
Phone
(919) 781-4060
Fax
(919) 781-5246
NPI assigned
Apr 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X A5480 NC Primary

Addresses

Primary practice location

3001 Edwards Mill Rd
Raleigh, NC 27612-5243

Mailing address

4813 Arbor Chase Dr
Raleigh, NC 27616-0734
Phone (919) 876-8899

Other practice location 1

4813 Arbor Chase Dr
Raleigh, NC 27616-0734
Phone (919) 876-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A5480NCMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1083009443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4813 ARBOR CHASE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276160734",
            "telephone_number": "919-876-8899",
            "fax_number": "919-876-8866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-781-4060",
            "fax_number": "919-781-5246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4813 Arbor Chase Dr",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276160734",
            "country_code": "US",
            "telephone_number": "919-876-8899",
            "fax_number": "919-876-8866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNK",
        "first_name": "BRIAN",
        "credential": "PTA/RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A5480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.