Basic Information
| Provider Information | |||||||||
| NPI: | 1972565042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANACH | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 22500 NE MARKETPLACE DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980532033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258361034 | ||||||||
| FaxNumber: | 4258361037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2250BA | 01 | WA | REGENCE | OTHER | 911745305-98053-A005 | 01 | WA | TRICARE | OTHER | P00353317 | 01 | WA | RAILROAD MEDICARE | OTHER | 0232276 | 01 | WA | LABOR & INDUSTRIES | OTHER | G8872200 | 01 | WA | MEDICARE | OTHER | 7312449 | 01 | WA | AETNA | OTHER | 8939859 | 01 | WA | L & I CRIME VICTIMS | OTHER | 0275625 | 01 | WA | L&I | OTHER | 0192795 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 5303BA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8340622 | 01 | WA | DSHS | OTHER | 9847BA | 01 | WA | REGENCE BLUE SHIELD | OTHER | P00473355 | 01 | WA | RAILROAD MEDICARE | OTHER | 0693BA | 01 | WA | REGENCE | OTHER |