Provider Demographics
NPI:1215604889
Name:BANTA, ROBERT JOHN JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:BANTA
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:ROBBIE
Other - Middle Name:JOHN
Other - Last Name:BANTA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2400 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6535
Mailing Address - Country:US
Mailing Address - Phone:504-894-2709
Mailing Address - Fax:
Practice Address - Street 1:2820 NAPOLEON AVE STE 610
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-8208
Practice Address - Country:US
Practice Address - Phone:504-894-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist