Functional Wellness LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

FUNCTIONAL WELLNESS LLC

Practice address

1611 N Broadway Ave
Oklahoma City, OK 73103-4610

Phone

(405) 277-0144

NPI assigned

Mar 31, 2023

Organization subpart

No

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

Authorized official

Name

Lori Mathews, LD

Title

Owner

Phone

(405) 277-0144

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1720783665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NE 2ND ST APT 401",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731042236",
            "telephone_number": "405-277-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 N BROADWAY AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731034610",
            "telephone_number": "405-277-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-277-0144",
        "authorized_official_credential": "LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha A Fulton
• Angela Fultz, M.A.
• Jeremy D Fultz
• Functional Assestment Centers of Oklahoma
• Functional Performance Training and Physical Therapy, PLLC
• Janet Leigh Fundaro, ARNP
• Beverly W Funderburk, PHD
• Charles Harwood Funderburk Jr., MD
• Kar-Ming A Fung, MD,PHD
• Rachel Funk-Lawler, PH.D.

• Registered Dietitian in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Registered Dietitian in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; 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.