Provider Demographics
NPI:1710291273
Name:RUNYAN, DENNIS LEE
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:LEE
Last Name:RUNYAN
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 1:2400 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-8878
Mailing Address - Country:US
Mailing Address - Phone:641-747-3225
Mailing Address - Fax:641-747-3045
Practice Address - Street 1:2400 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-8878
Practice Address - Country:US
Practice Address - Phone:641-747-3225
Practice Address - Fax:641-747-3045
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist