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General NPI Number Information
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NPI Number | 1285687970
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Entity Type | Individual
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Provider Name | TIMOTHY BANACH P.T.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 27040 CEDAR RD SUITE 201
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City | BEACHWOOD
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State | OH
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Zip | 44122-1115
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Country | US
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Telephone | 216-595-8290
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Fax | 216-621-5479
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Provider Business Mailing Address
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Address Line | 2500 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3204
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Country | US
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Telephone | 216-595-8290
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Fax | 216-621-5479
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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 | PT09551
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License Number State | OH
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