Provider Demographics
NPI:1093338238
Name:RUNQUIST, EMMA BARNES
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:BARNES
Last Name:RUNQUIST
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:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-0258
Mailing Address - Country:US
Mailing Address - Phone:641-351-8741
Mailing Address - Fax:
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4801
Practice Address - Country:US
Practice Address - Phone:603-823-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist