Individual
JOEL BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2777 JEFFERSON DAVIS HWY, SUITE 109, STAFFORD, VA 22554-8323
(540) 318-8615
Mailing address
2777 JEFFERSON DAVIS HWY, SUITE 109, STAFFORD, VA 22554-8323
(540) 318-8615
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603662
VA
Other
Enumeration date
08/10/2013
Last updated
08/10/2013
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