Individual
MILES JEFFREY BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
140 PINE GROVE CMNS, YORK, PA 17403-5151
(717) 851-5590
(717) 851-5957
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 851-5590
(717) 851-5957
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG002172
PA
Other
Enumeration date
10/21/2019
Last updated
10/22/2019
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