Provider Demographics
NPI:1578096103
Name:BANKS, FLOR M (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:FLOR
Middle Name:M
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81488
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1488
Mailing Address - Country:US
Mailing Address - Phone:907-460-6912
Mailing Address - Fax:
Practice Address - Street 1:3180 PEGER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5484
Practice Address - Country:US
Practice Address - Phone:907-460-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist