Provider Demographics
NPI:1689037814
Name:BANKS, MARIA JOSLYNNE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSLYNNE
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JOSLYNNE
Other - Last Name:FORSYTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2704 SUGAR MILL DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7694
Mailing Address - Country:US
Mailing Address - Phone:812-264-5073
Mailing Address - Fax:
Practice Address - Street 1:4900 SHAMROCK DR STE 100-102
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7325
Practice Address - Country:US
Practice Address - Phone:812-479-7337
Practice Address - Fax:812-550-1990
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2022-12-12
Deactivation Date:2022-09-22
Deactivation Code:
Reactivation Date:2022-11-10
Provider Licenses
StateLicense IDTaxonomies
IN05014759A225100000X, 2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program