Provider Demographics
NPI:1548376692
Name:BANIEWICZ, JAMES MATTHEW (PT, OCS, CERT MDT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:BANIEWICZ
Suffix:
Gender:M
Credentials:PT, OCS, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 NEWTOWN YARDLEY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1748
Mailing Address - Country:US
Mailing Address - Phone:215-860-7031
Mailing Address - Fax:215-860-5704
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?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-007232-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053758Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER