Provider Demographics
NPI:1225852734
Name:BANKER, PATRICK (PT, DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BANKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:BANKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1427 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3118
Mailing Address - Country:US
Mailing Address - Phone:415-895-1705
Mailing Address - Fax:
Practice Address - Street 1:460 BOULEVARD WAY STE 2D
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1563
Practice Address - Country:US
Practice Address - Phone:510-922-8872
Practice Address - Fax:510-291-2820
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist