Provider Demographics
NPI:1699041988
Name:RUNYON, SCOTT
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:RUNYON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 STERLING DR
Mailing Address - Street 2:STE 230
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7197
Mailing Address - Country:US
Mailing Address - Phone:810-229-0668
Mailing Address - Fax:928-222-0668
Practice Address - Street 1:5840 STERLING DR
Practice Address - Street 2:STE 230
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7197
Practice Address - Country:US
Practice Address - Phone:810-229-0668
Practice Address - Fax:928-222-0668
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist