Healthcare Provider Details

I. General information

NPI: 1598151995
Provider Name (Legal Business Name): PATRICIA RUNSER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 EDEN FARM CIR
WESTMINSTER MD
21157-4648
US

IV. Provider business mailing address

739 EDEN FARM CIR
WESTMINSTER MD
21157-4648
US

V. Phone/Fax

Practice location:
  • Phone: 443-244-7868
  • Fax:
Mailing address:
  • Phone: 443-244-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000039500
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: