Provider Demographics
NPI:1073540860
Name:RUNGE, NATHANIEL FRANCIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:FRANCIS
Last Name:RUNGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BRIDGTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3653
Mailing Address - Country:US
Mailing Address - Phone:207-797-3477
Mailing Address - Fax:207-797-8577
Practice Address - Street 1:23 BRIDGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3653
Practice Address - Country:US
Practice Address - Phone:207-797-3477
Practice Address - Fax:207-797-8577
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01061200208100000X
MEPT3488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09438287QMedicare ID - Type Unspecified