Individual
JONATHAN BANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PT
Contact information
Practice address
101 UNIVERSITY DR STE A6, AMHERST, MA 01002-2385
(413) 366-5703
(413) 992-2019
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17371
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0705080
—
MA
01
—
11516494
AETNA
MA
01
—
Y68515
BCBSMA
MA
Enumeration date
01/14/2007
Last updated
07/21/2022
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