Individual
BLAKE ARIEL BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2950 DONNELL DR STE G, FORESTVILLE, MD 20747-3277
(240) 492-3410
(301) 278-9852
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05015177A
IN
225100000X
Physical Therapist
070026352
IL
225100000X
Physical Therapist
27579
MD
Other
Enumeration date
11/28/2018
Last updated
05/20/2024
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