Provider Demographics
NPI:1295045730
Name:RUNGE, JODI RENEE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:RENEE
Last Name:RUNGE
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 S HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9332
Mailing Address - Country:US
Mailing Address - Phone:316-772-8638
Mailing Address - Fax:
Practice Address - Street 1:816 OAK ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-1813
Practice Address - Country:US
Practice Address - Phone:316-284-6510
Practice Address - Fax:316-284-6513
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04113225100000X
KS24-005862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer