Provider Demographics
NPI:1992834410
Name:BANYARD, DIANE B (M PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:BANYARD
Suffix:
Gender:F
Credentials:M PT
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Mailing Address - Street 1:PO BOX 21604
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0162
Mailing Address - Country:US
Mailing Address - Phone:540-725-5300
Mailing Address - Fax:540-725-5356
Practice Address - Street 1:7226B WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4264
Practice Address - Country:US
Practice Address - Phone:540-366-9244
Practice Address - Fax:540-366-9245
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305203035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013213S05Medicare PIN