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Individual

TAYLOR SCOTT RUNSICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
661 HIGHWAY 64B, WYNNE, AR 72396-8506
(870) 208-7877
Mailing address
302 EVELYN AVE E, WYNNE, AR 72396-3606
(870) 208-7877

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5409
AR
225200000X
Physical Therapy Assistant
3987
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
211-505-721
AR
Enumeration date
07/17/2015
Last updated
11/06/2023
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