Bradley Runia, PT
Individual provider Active NPI Physical Therapist · Ortonville, MN
NPI 1679533111 · NPPES record last updated Mar 25, 2010
Key facts
- NPI
- 1679533111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 6351 (MN)
- Practice address
- 820 Roy St
Ortonville, MN 56278-1138 - Phone
- (320) 839-4271
- Fax
- (320) 839-4196
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avera Marshall
Practice addresses (Care Compare)
1521 Carlson St
Marshall, MN 56258-2626
Phone (507) 532-9631
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9165
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060911000141 | MN | Practitioner - Physical Therapist in Private Practice | 9830112416 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-010805 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| Big Stone Therapies, Inc | Physical Therapist | Past | Accepting new patients |
| Avera Marshall | Past | Accepting new patients |
Locations
1420 E College Dr
Ste 704
Marshall, MN 56258
Phone (507) 532-3392
1521 Carlson St
#200
Marshall, MN 56258
Phone (507) 532-1901
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-010805 | IL | |
| Physical Therapist | 225100000X | 6351 | MN | Yes |
Addresses
Primary practice location
820 Roy St
Ortonville, MN 56278-1138
Mailing address
820 Roy St
Ortonville, MN 56278-1138
Phone (320) 839-4271
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 253693000 | Medicaid | MN |
Other providers in Ortonville, MN
- Gregory J. Peterson
- Tabitha Radermacher
- Allan E Ross
- Robert S Ross
- Paul Rudebusch
- Safe Phone Inc
- Sanford Health Network
- Emma Simonson
- Leslie Smith
- Catherine Snyder
All providers in Ortonville, MN · Physical Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.