Provider Demographics
NPI:1285718551
Name:RUNGE, JOANNA (LPT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:RUNGE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MORNINGSIDE LN
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-1347
Mailing Address - Country:US
Mailing Address - Phone:316-295-9226
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST STE 202A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3460
Practice Address - Country:US
Practice Address - Phone:316-295-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS470881661OtherCOMMERCIAL INS. ID
KS470881661OtherCOMMERCIAL INS. ID