Provider Demographics
NPI:1023584406
Name:RUNYAN, NICOLE NADEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NADEAN
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 TENNYSON ST APT 14
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2260
Mailing Address - Country:US
Mailing Address - Phone:503-709-0112
Mailing Address - Fax:
Practice Address - Street 1:4144 TENNYSON ST APT 14
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2260
Practice Address - Country:US
Practice Address - Phone:503-709-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist