Provider Demographics
NPI:1528168481
Name:RUNFOLA, SAMUEL THOMAS (MSPT, OCS)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:RUNFOLA
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Gender:M
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4924 CAMPBELL BLVD
Mailing Address - Street 2:SUITE 130-A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5908
Mailing Address - Country:US
Mailing Address - Phone:443-442-2050
Mailing Address - Fax:443-442-2054
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 130-A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:443-442-2050
Practice Address - Fax:443-442-2054
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD183102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic