Provider Demographics
NPI:1073600789
Name:RUNFOLA, KELLY ANN (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:RUNFOLA
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2111 FOLKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3312
Mailing Address - Country:US
Mailing Address - Phone:410-308-3630
Mailing Address - Fax:410-768-1203
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 302
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-768-1213
Practice Address - Fax:410-768-1203
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD182802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic