Provider Demographics
NPI:1063731321
Name:RUNYAN, STACIE LYNN (DPT)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:GELLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:4600 BOWLING BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5155
Practice Address - Country:US
Practice Address - Phone:502-895-7887
Practice Address - Fax:502-895-7887
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT005578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist