# BLAKE ARIEL BANNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1942770342
- **Gender:** F
- **Credential:** PT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 05015177A | IN | Yes |
| 225100000X | Physical Therapist | 070026352 | IL | — |
| 225100000X | Physical Therapist | 27579 | MD | — |

## Other

- **Enumeration date:** 11/28/2018
- **Last updated:** 05/20/2024