Provider Demographics
NPI:1154157964
Name:RUNQUIST, MELISSA (PT, DPT, PRPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:RUNQUIST
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 MONTEREY PINES ST APT B106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3201
Mailing Address - Country:US
Mailing Address - Phone:805-895-2140
Mailing Address - Fax:
Practice Address - Street 1:2415 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3819
Practice Address - Country:US
Practice Address - Phone:805-569-8999
Practice Address - Fax:805-687-5627
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist