=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477101061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARTOSZ MICHAL BANIA PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2019
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10512 PARK RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28210-8475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-541-6077
-----------------------------------------------------
Fax | 704-541-9295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7142 BROOKSTONE LN
-----------------------------------------------------
City | INDIAN LAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29707-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-265-0786
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | P18935
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT.9715
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------