Provider Demographics
NPI:1083851984
Name:BANEK, HARRY MANFRED WALDEN (BSC CMT)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:MANFRED WALDEN
Last Name:BANEK
Suffix:
Gender:M
Credentials:BSC CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 PLETTNER LN
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7380
Mailing Address - Country:US
Mailing Address - Phone:303-565-0791
Mailing Address - Fax:
Practice Address - Street 1:4602 PLETTNER LN
Practice Address - Street 2:UNIT 3A
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7380
Practice Address - Country:US
Practice Address - Phone:303-565-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist