Healthcare Provider Details

I. General information

NPI: 1629750278
Provider Name (Legal Business Name): ANNE COLETTE BANEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 GORDON NAGLE TRL
POTTSVILLE PA
17901-4203
US

IV. Provider business mailing address

5 KEITH CT
FLEETWOOD PA
19522-8542
US

V. Phone/Fax

Practice location:
  • Phone: 570-399-5331
  • Fax:
Mailing address:
  • Phone: 610-781-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT031431
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: