Dale Eugene Funk, P.T.

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT00006443 Issued in WA

Practice address

501 W 4TH Ave
Toppenish, WA 98948-1615

Phone

(509) 865-3141

Fax

(509) 865-7388

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Toppenish Physical Therapy Rehabilitation Center, Inc., P.S.

  • Specialist
  • Toppenish, WA
  • NPI 1245383314
  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1891848057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W 4TH AVE",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989481615",
            "telephone_number": "509-865-3141",
            "fax_number": "509-865-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W 4TH AVE",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989481615",
            "telephone_number": "509-865-3141",
            "fax_number": "509-865-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNK",
        "first_name": "DALE",
        "middle_name": "EUGENE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "PT00006443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN #",
            "identifier": "8208FU",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7123979",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8397143",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "R12118",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PIN #",
            "identifier": "12566",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH GROUP #",
            "identifier": "2400",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & IND. GROUP #",
            "identifier": "0178563",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & IND. PIN #",
            "identifier": "0178562",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackie Lee Follansbee, RN, BSN
• Elizabeth Frausto, CASE MANAGER
• Andrea Danielle French, MSW
• Brandon Michael Fuellas, RN
• Lindsey Fulton
• Marcie Ganuelas, CO60951248
• Angela Garcia, LMP, PTA
• Lauryl Garcia
• Tanya Leeanne Garcia, RN
• Dylan Avery Gardner, PHARMD

• Specialist in Toppenish, WA
• Providers in Toppenish, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.