Healthcare Provider Details

I. General information

NPI: 1376600668
Provider Name (Legal Business Name): MARK STANLEY RUNDEL L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 12TH AVE SUITE 30
SEATTLE WA
98122-2467
US

IV. Provider business mailing address

6743 5TH AVE NW
SEATTLE WA
98117-5014
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-5744
  • Fax:
Mailing address:
  • Phone: 206-324-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMA00006014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: