Provider Demographics
NPI:1508401738
Name:BANNISTER, EMILY CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5795 LEWISTON RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA UNIVERSITY
Mailing Address - State:NY
Mailing Address - Zip Code:14109-9809
Mailing Address - Country:US
Mailing Address - Phone:716-286-8612
Mailing Address - Fax:716-286-8656
Practice Address - Street 1:5795 LEWISTON RD
Practice Address - Street 2:
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109-9809
Practice Address - Country:US
Practice Address - Phone:716-286-8612
Practice Address - Fax:716-286-8656
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer