Provider Demographics
NPI:1366692204
Name:RUNYON, LORI ANN
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
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:PO BOX 296
Mailing Address - Street 2:10638 LONG LANE
Mailing Address - City:FANNETTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17221-0296
Mailing Address - Country:US
Mailing Address - Phone:717-957-6687
Mailing Address - Fax:
Practice Address - Street 1:10638 LONG DRIVE
Practice Address - Street 2:
Practice Address - City:FANNETTSBURG
Practice Address - State:PA
Practice Address - Zip Code:17221-0296
Practice Address - Country:US
Practice Address - Phone:717-957-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001530L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant