Provider Demographics
NPI:1598811929
Name:BANIEWICZ, DONNA M (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:BANIEWICZ
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:770 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1748
Practice Address - Country:US
Practice Address - Phone:215-860-7031
Practice Address - Fax:215-860-5704
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-007340-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001345806OtherBLUE SHIELD NUMBER