Individual
DEBRA SHALEEN RUNNELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1444
AR
225200000X
Physical Therapy Assistant
Primary
PTA1444
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139168721
—
AR
Enumeration date
01/14/2011
Last updated
02/04/2022
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