IDA MARIELKE FUNKE (NPI# 1851872428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851872428 |
| Entity Type | Individual |
| Full Name | IDA MARIELKE FUNKE |
| Credential | PT |
| Practice Address |
1111 Crater Lake Ave Medford OR 97504-6241 |
| Practice Telephone | 5417325028 |
| Mailing Telephone | 5417325028 |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2018-08-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251G0304X |
Physical Therapist Specialization: Geriatrics |
02851 | OR | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1111 CRATER LAKE AVE |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-6241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558361378 | Craig S. Thalacker | Emergency Medicine | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2005-07-22 |
| 1447865464 | Annabel M Walker | Nurse Practitioner | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2020-09-15 |
| 1386256519 | Ryan Tierney | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2020-08-19 |
| 1992362867 | Courtney Howarth | Physical Therapy Assistant | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2019-05-24 |
| 1811470107 | Nicole Marie Choyce | Dietitian, Registered | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-09-12 |
| 1336621721 | Tai Bailey Shelton | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-31 |
| 1932681533 | Jacqueline Lucas-morris | Occupational Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-30 |
| 1477035236 | Sarah Rae Hanley | Occupational Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-29 |
| 1306327242 | Elizabeth Carlton | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-28 |
| 1467932327 | Sarah Mccrate | Occupational Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 2251G0304X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Geriatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134608144 | Michael Nelson | Physical Therapist | 1111 Crater Lake Ave, Medford, OR 97504-6241 | 2018-08-09 |
| 1649662958 | Ingrid Emata | Physical Therapist | 760 Spring St, Medford, OR 97504-6131 | 2015-02-23 |
| 1659778041 | Bethany Diehl | Physical Therapist | 691 Murphy Rd, Medford, OR 97504-4346 | 2014-12-01 |
| 1700048444 | Sue R Wright | Physical Therapist | 835 Crater Lake Ave, Medford, OR 97504-6505 | 2008-06-25 |
| 1679733539 | Linda Beth Frisbey | Physical Therapist | 2901 E Barnett Rd, Medford, OR 97504-8308 | 2008-06-13 |
| 1336362094 | Angela Plummer | Physical Therapist | 200 Governors Ave, Medford, MA 02155-1644 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841898335 | Denise Marie Wilkinson | Physical Therapist | 17550 Provost St Ste 201a, Lake Oswego, OR 97034-5199 | 2020-10-15 |
| 1295290674 | Gregory Charles Helms | Physical Therapist | 2020 Nw Fawnee Dr, Corvallis, OR 97330-2869 | 2019-02-09 |
| 1770943706 | Noreen P Caulfield | Physical Therapist | 6326 Se 67th Ave, Portland, OR 97206-6504 | 2016-03-03 |
| 1427465962 | Kelsey Wilde | Physical Therapist | 441 Werth Blvd., Newberg, OR 97123 | 2014-07-16 |
| 1881004216 | Arleen Norkitis | Physical Therapist | 7320 Sw Hunziker, Suite 203, Tigard, OR 97223 | 2014-05-07 |
| 1528407434 | Roberta Ann Fort | Physical Therapist | 8881 Nw Pike Rd, Yamhill, OR 97148-8208 | 2013-06-24 |
| 1255698411 | Eric J Smith | Physical Therapist | 7805 Se 35th Ave, Portland, OR 97202-8409 | 2012-04-12 |
| 1588974984 | Balance & Low Vision Solutions, LLC | Physical Therapist | 2846 Sw Multnomah Blvd, Portland, OR 97219-3936 | 2010-10-19 |
| 1780908749 | Ayako Sakata | Physical Therapist | 30900 Sw Parkway Ave., Wilsonville, OR 97070 | 2010-03-19 |
| 1982931747 | Sarah Logan | Physical Therapist | 346 S 42nd Pl, Springfield, OR 97478-5933 | 2009-11-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.