Provider Demographics
NPI:1215551734
Name:BANKSON, KUMIKO
Entity Type:Individual
Prefix:
First Name:KUMIKO
Middle Name:
Last Name:BANKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BRYCE LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7038
Mailing Address - Country:US
Mailing Address - Phone:940-241-1215
Mailing Address - Fax:940-455-2041
Practice Address - Street 1:4040 BRYCE LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75077-7038
Practice Address - Country:US
Practice Address - Phone:940-241-1215
Practice Address - Fax:940-455-2041
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31252532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic