Provider Demographics
NPI:1689685059
Name:ROBERT RUNGE DBA EXCEL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ROBERT RUNGE DBA EXCEL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RUNGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:920-233-8739
Mailing Address - Street 1:420 N KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4111
Mailing Address - Country:US
Mailing Address - Phone:920-233-8739
Mailing Address - Fax:920-233-8732
Practice Address - Street 1:420 N KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4111
Practice Address - Country:US
Practice Address - Phone:920-233-8739
Practice Address - Fax:920-233-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40420300Medicaid
WV000086591Medicare ID - Type UnspecifiedMEDICARE NUMBER