Individual
HEATHER E BANIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2454 WEST CLAY, ST CHARLES, MO 63301-2548
(636) 949-3926
(636) 949-3928
Mailing address
607 DEWEY AVE NW, STE 300, GRAND RAPIDS, MI 49504-7335
(616) 356-5000
(636) 356-5001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2009020457
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12480681
CAQH
MO
01
—
P01170364
RAILROAD MEDICARE
MO
Enumeration date
07/21/2009
Last updated
08/23/2016
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