Provider Demographics
NPI:1639962533
Name:RUNKLE, ERIKA BETH (LMT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:BETH
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37561 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9112
Mailing Address - Country:US
Mailing Address - Phone:863-289-8836
Mailing Address - Fax:
Practice Address - Street 1:18859 S. HURON RIVER DR.
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:MI
Practice Address - Zip Code:48164
Practice Address - Country:US
Practice Address - Phone:863-289-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist