Provider Demographics
NPI:1790047355
Name:RUNYAN, AMANDA DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:DAWN
Other - Last Name:RUNYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:600 PLEASANT AVE.
Mailing Address - Street 2:ST. JOSEPH'S AREA HEALTH SERVICES
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-237-5496
Mailing Address - Fax:218-237-5702
Practice Address - Street 1:600 PLEASANT AVE.
Practice Address - Street 2:ST. JOSEPH'S AREA HEALTH SERVICES
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470
Practice Address - Country:US
Practice Address - Phone:218-237-5496
Practice Address - Fax:218-237-5702
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist