Individual
BARBARA BANANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,DPT
Contact information
Practice address
39 6TH AVE # 3304, PAGE, AZ 86040-0470
(212) 444-2678
Mailing address
PO BOX 1814, PAGE, AZ 86040-1814
(212) 444-2678
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
013382
AZ
Other
Enumeration date
10/01/2019
Last updated
05/06/2020
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