Individual
KENNETH G BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
302 26TH AVENUE EAST, APT 101, BRADENTON, FL 34205
(941) 962-7542
Mailing address
302 26TH AVE E, APT 101, BRADENTON, FL 34205
(941) 962-7542
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA71840
FL
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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