Basic Information
| Provider Information | |||||||||
| NPI: | 1730420274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANOUB | ||||||||
| FirstName: | MARIEM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617919090 | ||||||||
| FaxNumber: | 5617919071 | ||||||||
| Practice Location | |||||||||
| Address1: | 7115 LAKE WORTH RD | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334672906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613187432 | ||||||||
| FaxNumber: | 5614298983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2013 | ||||||||
| LastUpdateDate: | 03/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT28015 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.