Provider Demographics
NPI:1740512763
Name:RUNQUIST, MOLLY ANN (DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:RUNQUIST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:TEMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:4120 38TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-517-0013
Practice Address - Fax:309-894-1013
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004527225100000X
IL070-027052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist