Individual
MR. KRAIG Y BANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT CHT
Contact information
Practice address
9475 ROOSEVELT BLVD, PHILADELPHIA, PA 19114-2212
(215) 464-6200
(215) 464-9834
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
2251H1200X
Hand Physical Therapist
Primary
PT011023L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000037582
—
DE
01
—
1667747
PABS
—
01
—
234323000
IBC
—
01
—
5070-0003
CARE FIRST
—
01
—
61809102
CAREFIRST
—
Enumeration date
07/29/2006
Last updated
09/25/2013
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