Provider Demographics
NPI:1639846447
Name:RUNNELS, CACY
Entity Type:Individual
Prefix:
First Name:CACY
Middle Name:
Last Name:RUNNELS
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 92
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-0092
Mailing Address - Country:US
Mailing Address - Phone:720-361-7791
Mailing Address - Fax:
Practice Address - Street 1:5912 S CODY ST STE 215
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-9544
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist