MEDICARE: STEPHEN W. BANNISTER 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
1	225100000X	Physical Therapist	PT005883L	PA

General Provider Information

NPI Number	:	1396720546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN W. BANNISTER PT

Provider Business Mailing Address
First Line	:	445 GREENSBURG AVE
Second Line	:
City	:	EAST MC KEESPORT
State	:	PA
Zip	:	15035-1417
Country	:	US
Telephone Number	:	412-816-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 GREENSBURG AVE
Second Line	:
City	:	EAST MC KEESPORT
State	:	PA
Zip	:	15035-1417
Country	:	US
Telephone Number	:	412-816-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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Directions to “ STEPHEN W. BANNISTER PT” Practice Location

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