Provider Demographics
NPI:1992148795
Name:BANKS, FREDERICK A SR
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
Last Name:BANKS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MELIC WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7890
Mailing Address - Country:US
Mailing Address - Phone:702-274-7431
Mailing Address - Fax:
Practice Address - Street 1:1001 MELIC WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7890
Practice Address - Country:US
Practice Address - Phone:702-274-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner