Individual
JONATHAN BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.T.
Contact information
Practice address
112 E 12TH ST, ALTURAS, CA 96101-3306
(530) 249-5352
Mailing address
112 E 12TH ST, ALTURAS, CA 96101-3306
(530) 249-5352
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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