Provider Demographics
NPI:1093338238
Name:RUNQUIST, EMMA BARNES (DPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:BARNES
Last Name:RUNQUIST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ALPINE PLACE DR UNIT 110
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5277
Mailing Address - Country:US
Mailing Address - Phone:603-447-2533
Mailing Address - Fax:
Practice Address - Street 1:64 HOBBS ST # 3
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6251
Practice Address - Country:US
Practice Address - Phone:603-242-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist