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General NPI Number Information
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NPI Number | 1508440587
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Entity Type | Individual
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Provider Name | DANA RENE' BANFIELD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 18441 N 87TH AVE
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City | PEORIA
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State | AZ
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Zip | 85382-8532
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Country | US
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Telephone | 315-335-9130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 132
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City | BLACK CANYON CITY
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State | AZ
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Zip | 85324-0132
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Country | US
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Telephone | 602-717-3641
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 010335
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License Number State | AZ
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