Individual
JONATHAN BANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PT
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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