Tristan George Runyon

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P161362588 Issued in WA

Practice address

9514 4TH St NE Unit 101
Lake Stevens, WA 98258-1937

Phone

(425) 397-2327

NPI assigned

Jan 30, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1669188967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 140TH ST NW",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982716795",
            "telephone_number": "630-999-5466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9514 4TH ST NE UNIT 101",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982581937",
            "telephone_number": "425-397-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYON",
        "first_name": "TRISTAN",
        "middle_name": "GEORGE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P161362588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi P Rodriguez, MDA, RDN
• Kristin Lee Roessler, LMHC
• Laura Rogstad, PSYD
• Royale Realty LLC
• RSL Lake Stevens, LLC
• RVC Interpreters LLC
• Alicia Marie Ryan
• Sabra West Coast Operations V, LLC
• Romany Raafat Zaki Sadek
• Safeway Inc

• Physical Therapy Assistant in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.