Individual
MR. JOHN F BANASZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
314 N 9TH ST, MOUNT VERNON, WA 98273-3327
(360) 428-6100
Mailing address
PO BOX 598, LA CONNER, WA 98257-0598
(360) 466-9982
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/20/2006
Last updated
07/08/2007
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