MEDICARE: MADELYNNE GRACE RUNYON MSAT, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	36003897A	IN

General Provider Information

NPI Number	:	1164140059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYNNE GRACE RUNYON MSAT, LAT, ATC

Provider Business Mailing Address
First Line	:	844 SETTLERS WALK
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7564
Country	:	US
Telephone Number	:	317-409-9156
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 W WABASH AVE
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-2428
Country	:	US
Telephone Number	:	765-361-6366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	12/10/2025

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