Provider Demographics
NPI:1487030284
Name:BANKS, SHEA (DPT)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25B S PINE ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2113
Mailing Address - Country:US
Mailing Address - Phone:443-417-5253
Mailing Address - Fax:
Practice Address - Street 1:2821 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9213
Practice Address - Country:US
Practice Address - Phone:717-840-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT024530OtherSTATE PHYSICAL THERAPY LICENSE