Provider Demographics
NPI:1235197740
Name:BANTON, CARRIE DIETZ (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:DIETZ
Last Name:BANTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1708
Mailing Address - Country:US
Mailing Address - Phone:717-943-1888
Mailing Address - Fax:717-943-1887
Practice Address - Street 1:319 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1708
Practice Address - Country:US
Practice Address - Phone:717-943-1888
Practice Address - Fax:717-943-1887
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013181L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist