Provider Demographics
NPI:1679167787
Name:FUNDERBURK, KIONDRA
Entity type:Individual
Prefix:
First Name:KIONDRA
Middle Name:
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 CARDINAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4984
Mailing Address - Country:US
Mailing Address - Phone:704-957-7394
Mailing Address - Fax:
Practice Address - Street 1:3305 CARDINAL LAKE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4984
Practice Address - Country:US
Practice Address - Phone:704-957-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty