Provider Demographics
NPI:1215077904
Name:RUNNELS, MARSHA K (PT)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:K
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARSHA
Other - Middle Name:D
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:36 BASS RD
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-3121
Mailing Address - Country:US
Mailing Address - Phone:903-786-8986
Mailing Address - Fax:
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:STE 120
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-957-0385
Practice Address - Fax:903-957-4006
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1105799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist