Active NPI
Jennifer G Funke, PT
- Physical Therapist
- Poplar Bluff, MO
National Provider Identifier
1912963398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2003022299
- Practice address
- 3381 Kanell Blvd
Poplar Bluff, MO 63901-3060 - Phone
- (573) 775-0761
- Fax
- (573) 785-0031
- NPI assigned
- Apr 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2003022299 | MO | Primary |
Addresses
Primary practice location
3381 Kanell Blvd
Poplar Bluff, MO 63901-3060
Mailing address
PO Box 1064
Poplar Bluff, MO 63902-1064
Phone (573) 778-9348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 486083702 | Medicaid | MO |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2003022299 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardio Pulmonary Rehab | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Registered Dietitian
- Poplar Bluff, MO
- NPI 1770555674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376956800000",
"number": "1912963398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1064",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639021064",
"telephone_number": "573-778-9348",
"fax_number": "573-686-0178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3381 KANELL BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013060",
"telephone_number": "573-775-0761",
"fax_number": "573-785-0031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNKE",
"first_name": "JENNIFER",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-25",
"last_updated": "2013-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2003022299",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "486083702",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.