Provider Demographics
NPI:1669203204
Name:RUNIONS, JACOB (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:RUNIONS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W MORRIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2237
Mailing Address - Country:US
Mailing Address - Phone:423-375-8907
Mailing Address - Fax:423-822-5514
Practice Address - Street 1:410 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6606
Practice Address - Country:US
Practice Address - Phone:423-381-8813
Practice Address - Fax:423-254-5311
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist