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General NPI Number Information
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NPI Number | 1255909792
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Entity Type | Individual
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Provider Name | MADISON IRENE RUNNION
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Gender | Female
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 1 AEROSPACE BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3910
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Country | US
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Telephone | 316-322-5496
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Fax |
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Provider Business Mailing Address
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Address Line | 8160 N HOOVER RD
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City | VALLEY CENTER
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State | KS
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Zip | 67147-8377
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Country | US
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Telephone | 316-322-5496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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