Provider Demographics
NPI:1326069535
Name:BANKIE, EDA LOUISE
Entity Type:Individual
Prefix:
First Name:EDA
Middle Name:LOUISE
Last Name:BANKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDA
Other - Middle Name:
Other - Last Name:BANKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:101 SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1608
Mailing Address - Country:US
Mailing Address - Phone:415-892-6486
Mailing Address - Fax:415-892-6486
Practice Address - Street 1:101 SAN CARLOS WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1608
Practice Address - Country:US
Practice Address - Phone:415-892-6486
Practice Address - Fax:415-892-6486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist