Healthcare Provider Details

I. General information

NPI: 1710291273
Provider Name (Legal Business Name): DENNIS LEE RUNYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 POPLAR AVE
GUTHRIE CENTER IA
50115-8878
US

IV. Provider business mailing address

2400 POPLAR AVE
GUTHRIE CENTER IA
50115-8878
US

V. Phone/Fax

Practice location:
  • Phone: 641-747-3225
  • Fax: 641-747-3045
Mailing address:
  • Phone: 641-747-3225
  • Fax: 641-747-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1128
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: