Provider Demographics
NPI:1164872362
Name:BANKS, KATRINA (PT, DPT, CSRS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:PT, DPT, CSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HUNT ST STE 207
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 HUNT ST STE 207
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1913
Practice Address - Country:US
Practice Address - Phone:413-318-4776
Practice Address - Fax:413-358-4624
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist