MEDICARE: RUNN VERMEL CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1730370537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUNN VERMEL CMT

Provider Business Mailing Address
First Line	:	530 E 8TH ST
Second Line	:	STE 107
City	:	OAKLAND
State	:	CA
Zip	:	94606-2820
Country	:	US
Telephone Number	:	510-706-2022
Fax Number	:	510-452-5683

Provider Business Practice Location Address
First Line	:	6355 TELEGRAPH AVE
Second Line	:	STE 208
City	:	OAKLAND
State	:	CA
Zip	:	94609-1371
Country	:	US
Telephone Number	:	510-706-2022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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