MEDICARE: SANDRA LEE BANZET P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00009044	WA

General Provider Information

NPI Number	:	1730343229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LEE BANZET P.T.

Provider Business Mailing Address
First Line	:	801 E FRONT ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3636
Country	:	US
Telephone Number	:	360-417-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 E FRONT ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3636
Country	:	US
Telephone Number	:	360-457-0681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	06/23/2026

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