Provider Demographics
NPI:1790407930
Name:BANKS, DYLAN JAMES (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:BANKS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
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 922
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0922
Mailing Address - Country:US
Mailing Address - Phone:866-309-5567
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:3519 N GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1347
Practice Address - Country:US
Practice Address - Phone:812-437-1420
Practice Address - Fax:812-437-1425
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014776A225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist