Provider Demographics
NPI:1326240540
Name:RUNNOE, CANDY M (PT)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:M
Last Name:RUNNOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:M
Other - Last Name:BACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4382
Mailing Address - Country:US
Mailing Address - Phone:715-226-1545
Mailing Address - Fax:
Practice Address - Street 1:8 EAGLE LAKE DR
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4382
Practice Address - Country:US
Practice Address - Phone:715-226-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10305225100000X
FL29632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist