Provider Demographics
NPI:1477101061
Name:BANIA, BARTOSZ MICHAL (PT)
Entity Type:Individual
Prefix:
First Name:BARTOSZ
Middle Name:MICHAL
Last Name:BANIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8037 CLEMS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-0028
Mailing Address - Country:US
Mailing Address - Phone:413-265-0786
Mailing Address - Fax:
Practice Address - Street 1:231 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1159
Practice Address - Country:US
Practice Address - Phone:803-366-4415
Practice Address - Fax:803-366-1885
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.9715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist