Provider Demographics
NPI:1841919610
Name:RUNYAN, ALYSSA MARY (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARY
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MCGEE ST UNIT 928
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2226
Mailing Address - Country:US
Mailing Address - Phone:856-266-6918
Mailing Address - Fax:
Practice Address - Street 1:1 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-1651
Practice Address - Country:US
Practice Address - Phone:816-920-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240286932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer