Provider Demographics
NPI:1871681379
Name:BANKS, GAGE (PT)
Entity Type:Individual
Prefix:PROF
First Name:GAGE
Middle Name:
Last Name:BANKS
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 1:2340 GARDEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5347
Mailing Address - Country:US
Mailing Address - Phone:831-250-0005
Mailing Address - Fax:831-250-0017
Practice Address - Street 1:2340 GARDEN RD STE 101
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5347
Practice Address - Country:US
Practice Address - Phone:831-250-0005
Practice Address - Fax:831-250-0017
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H500CC30Medicare ID - Type UnspecifiedMEDICARE NUMBER