Provider Demographics
NPI:1255669289
Name:BANKSTON, LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:BANKSTON
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 1:11923 MIDDLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2521
Mailing Address - Country:US
Mailing Address - Phone:813-957-7174
Mailing Address - Fax:
Practice Address - Street 1:11923 MIDDLEBURY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2521
Practice Address - Country:US
Practice Address - Phone:813-957-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist