Provider Demographics
NPI:1972565042
Name:BANACH, JOSEPH G (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:BANACH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:22500 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2033
Practice Address - Country:US
Practice Address - Phone:425-836-1034
Practice Address - Fax:425-836-1037
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2250BAOtherREGENCE
WA911745305-98053-A005OtherTRICARE
WAP00353317OtherRAILROAD MEDICARE
WA0232276OtherLABOR & INDUSTRIES
WAG8872200OtherMEDICARE
WA7312449OtherAETNA
WA8939859OtherL & I CRIME VICTIMS
WA0275625OtherL&I
WA0192795OtherDEPT. OF LABOR & INDUSTRY
WA5303BAOtherREGENCE BLUE SHIELD
WA8340622OtherDSHS
WA9847BAOtherREGENCE BLUE SHIELD
WAP00473355OtherRAILROAD MEDICARE
WA0693BAOtherREGENCE
WA7312449OtherAETNA
WA911745305-98053-A005OtherTRICARE
WAG8862533Medicare PIN