Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blake Ariel Banner, PT

Individual provider Physical Therapist · NPI 1942770342

Blake Ariel Banner, PT is a Physical Therapist in Private Practice in Forestville, Maryland. Qualified in 2017, 9 years ago. Practices with Athletico Ltd, a 2,186-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Illinois, Indiana and Maryland.

Years since qualifying
9
Licensed in
IL, IN, MD
In the registry since
2018
Specialties on file
3
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

See every abbreviation used in this directory →

Practice location Address checks out

2950 Donnell Dr Ste G
Forestville, MD 20747-3277
Phone: (240) 492-3410
Fax: (301) 278-9852
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2875 Crain Hwy Ste 6, Waldorf, MD 20601-2841 — (301) 859-3304
  • 200 Patewood Dr Ste C150, Greenville, SC 29615-6323 — (864) 454-0904

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 05015177A (IN)
Physical Therapist Taxonomy 225100000X · Licence 070026352 (IL)
Physical Therapist Taxonomy 225100000X · Licence 27579 (MD)

Record details

NPI number1942770342
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorNo
NPI enumeratedNovember 28, 2018
Last updated in NPPESMay 20, 2024
Certification dateMay 20, 2024
Mailing address790 Remington Blvd, Bolingbrook, IL 60440-4909

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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