Healthcare Provider Details

I. General information

NPI: 1821926775
Provider Name (Legal Business Name): JULIA RYANN BANFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 S FITNESS PL STE 100
EAGLE ID
83616-6568
US

IV. Provider business mailing address

1319 N WEBB WAY
MERIDIAN ID
83642-1085
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-3332
  • Fax:
Mailing address:
  • Phone: 650-464-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3081313
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: