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NPI Code Detail

MEDICARE: MS. MICHELLE M BANAZWSKI PT

MEDICARE: MS. MICHELLE M BANAZWSKI PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305207290VA
2225100000XPhysical Therapist4619SC

General Provider Information

NPI Number : 1255305983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE M BANAZWSKI PT
Provider Business Mailing Address
First Line : 808 LE COVE CT
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-1652
Country : US
Telephone Number : 843-693-1747
Fax Number :
Provider Business Practice Location Address
First Line : 1309 KEMPSVILLE RD
Second Line :
City : NORFOLK
State : VA
Zip : 23502-2205
Country : US
Telephone Number : 757-461-5001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 01/08/2026

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