Provider Demographics
NPI:1164140059
Name:RUNYON, MADELYNNE GRACE
Entity Type:Individual
Prefix:
First Name:MADELYNNE
Middle Name:GRACE
Last Name:RUNYON
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 1:844 SETTLERS WALK
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7564
Mailing Address - Country:US
Mailing Address - Phone:317-409-9156
Mailing Address - Fax:
Practice Address - Street 1:2087 ACORN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7306
Practice Address - Country:US
Practice Address - Phone:317-738-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer