Provider Demographics
NPI:1255791737
Name:RUNKO, CHRIS (LMT)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:RUNKO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1013
Mailing Address - Country:US
Mailing Address - Phone:631-455-4888
Mailing Address - Fax:
Practice Address - Street 1:11 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1013
Practice Address - Country:US
Practice Address - Phone:631-455-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020752225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist