Healthcare Provider Details

I. General information

NPI: 1063806909
Provider Name (Legal Business Name): JULIE ANN BANTA PT, DPT, FAAOMPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

IV. Provider business mailing address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 240-612-2464
  • Fax:
Mailing address:
  • Phone: 240-612-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15518
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: