Healthcare Provider Details

I. General information

NPI: 1053949792
Provider Name (Legal Business Name): CAITLIN RUNK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3347
US

IV. Provider business mailing address

306 HENRIETTA MOUNTAIN RD
SAXTON PA
16678-8160
US

V. Phone/Fax

Practice location:
  • Phone: 888-531-2204
  • Fax:
Mailing address:
  • Phone: 814-515-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI005163
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: