Provider Demographics
NPI:1851585533
Name:BANKSON, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BANKSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S STATE ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4469
Mailing Address - Country:US
Mailing Address - Phone:507-238-4949
Mailing Address - Fax:507-238-3377
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-4949
Practice Address - Fax:507-238-3377
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
62619OtherSANFORD HEALTH
MN096N3BAOtherBLUE CROSS BLUE SHIELD
18725OtherAVERA
974311051596OtherPREFERREDONE
MN490047000Medicaid
18725OtherAVERA