Provider Demographics
NPI:1063836179
Name:BANKSTAHL, JULIE MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:BANKSTAHL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 RICK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2951
Mailing Address - Country:US
Mailing Address - Phone:586-566-0326
Mailing Address - Fax:
Practice Address - Street 1:14153 RICK DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-2951
Practice Address - Country:US
Practice Address - Phone:586-566-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist