Healthcare Provider Details

I. General information

NPI: 1104363506
Provider Name (Legal Business Name): SARAH RUNYON MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 COBBLESTONE DR
COLORADO SPRINGS CO
80906-4818
US

IV. Provider business mailing address

366 COBBLESTONE DR
COLORADO SPRINGS CO
80906-4818
US

V. Phone/Fax

Practice location:
  • Phone: 269-325-4055
  • Fax:
Mailing address:
  • Phone: 269-325-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: