Functional Physical Therapy Center

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT670 Issued in ID

Legal business name

FUNCTIONAL PHYSICAL THERAPY CENTER

Practice address

8950 W Emerald St
Suite 195
Boise, ID 83704-4854

Phone

(208) 376-7313

Fax

(208) 376-7487

NPI assigned

Oct 31, 2011

Organization subpart

No

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

Authorized official

Name

Rajcoomar Issuree, P.T.

Title

Physical Therapist/Director

Phone

(208) 376-7313

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334534400000",
    "number": "1902182298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8950 W EMERALD ST",
            "address_2": "SUITE 195",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044854",
            "telephone_number": "208-376-7313",
            "fax_number": "208-376-7487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 W EMERALD ST",
            "address_2": "SUITE 195",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044854",
            "telephone_number": "208-376-7313",
            "fax_number": "208-376-7487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL PHYSICAL THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2012-04-16",
        "status": "A",
        "authorized_official_last_name": "ISSUREE",
        "authorized_official_first_name": "RAJCOOMAR",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/DIRECTOR",
        "authorized_official_telephone_number": "208-376-7313",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ID",
            "license": "PT670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Nixon Fultz, COMS
• Darby Fulwider
• Vicki Funaiole
• Functional and Integrative Medicine of Idaho PA
• Functional Medicine of Idaho PC
• Mon-Yee Fung
• Heidi Funk
• Nicole Marie Funk, PA-C
• Timothy Franklin Funk, FNP-C
• Aleesia Funke, LMSW

• Physical Therapy Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; 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.