Individual
JULIE BANASZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-6550
Mailing address
171 KEMPSVILLE RD BLDG A, NORFOLK, VA 23502-4700
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000663
VA
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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