Individual
STACIE BANZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1145 DUNBAR AVENUE, DUNBAR, WV 25064-2506
(304) 400-4896
Mailing address
PO BOX 398, SALT ROCK, WV 25559-0398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
WV
Other
Enumeration date
11/20/2020
Last updated
11/20/2020
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