Provider Demographics
NPI:1265469290
Name:BANKS, MARLA DENEEN (ATC MED)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:DENEEN
Last Name:BANKS
Suffix:
Gender:F
Credentials:ATC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3729
Mailing Address - Country:US
Mailing Address - Phone:609-929-9000
Mailing Address - Fax:
Practice Address - Street 1:58 MEADOW CT
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3729
Practice Address - Country:US
Practice Address - Phone:609-929-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer