Healthcare Provider Details

I. General information

NPI: 1275798159
Provider Name (Legal Business Name): JILL DEHNER BANYAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CAPITOL CT NE STE 100
WASHINGTON DC
20002-7705
US

IV. Provider business mailing address

524 LYNCH ST
ROCKVILLE MD
20850-2116
US

V. Phone/Fax

Practice location:
  • Phone: 202-524-2320
  • Fax:
Mailing address:
  • Phone: 530-386-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT871492
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205557
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number25052
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305205557
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25052
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: