Provider Demographics
NPI:1548412281
Name:BANKS, NICOLE TERESE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TERESE
Last Name:BANKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DELAWARE RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2743
Mailing Address - Country:US
Mailing Address - Phone:716-876-3901
Mailing Address - Fax:
Practice Address - Street 1:1 DELAWARE RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2743
Practice Address - Country:US
Practice Address - Phone:716-876-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist