Provider Demographics
NPI:1811650328
Name:RUNTE, SUSAN (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RUNTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 TIMBER RDG
Mailing Address - Street 2:
Mailing Address - City:LARUE
Mailing Address - State:TX
Mailing Address - Zip Code:75770-5029
Mailing Address - Country:US
Mailing Address - Phone:903-284-0516
Mailing Address - Fax:
Practice Address - Street 1:8920 TIMBER RDG
Practice Address - Street 2:
Practice Address - City:LARUE
Practice Address - State:TX
Practice Address - Zip Code:75770-5029
Practice Address - Country:US
Practice Address - Phone:903-284-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist