Provider Demographics
NPI:1366539702
Name:RUNGSRIWONG, VARUNEE (PT, IMT, C)
Entity type:Individual
Prefix:
First Name:VARUNEE
Middle Name:
Last Name:RUNGSRIWONG
Suffix:
Gender:F
Credentials:PT, IMT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 W PARK AVE
Practice Address - Street 2:STE. 250
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3357
Practice Address - Country:US
Practice Address - Phone:630-279-0032
Practice Address - Fax:630-279-1833
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700007623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47983Medicare PIN
ILK16357Medicare PIN