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General NPI Number Information
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NPI Number | 1255305983
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Entity Type | Individual
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Provider Name | MICHELLE M BANAZWSKI PT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1309 KEMPSVILLE RD
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City | NORFOLK
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State | VA
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Zip | 23502-2205
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Country | US
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Telephone | 757-461-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 808 LE COVE CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-1652
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Country | US
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Telephone | 843-693-1747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305207290
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4619
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License Number State | SC
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