Provider Demographics
NPI:1306442090
Name:BANAS, JEREMY JARABAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JARABAS
Last Name:BANAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 RALPH MCGILL BLVD NE UNIT 504
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1197
Mailing Address - Country:US
Mailing Address - Phone:301-706-2511
Mailing Address - Fax:
Practice Address - Street 1:4700 NELSON BROGDON BLVD STE 240
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5401
Practice Address - Country:US
Practice Address - Phone:770-271-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist