Provider Demographics
NPI:1881027951
Name:BANKS, JONATHAN PHILIP (PTA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PHILIP
Last Name:BANKS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LEMMON HILL LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4239
Mailing Address - Country:US
Mailing Address - Phone:410-334-3563
Mailing Address - Fax:
Practice Address - Street 1:300 LEMMON HILL LN
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4239
Practice Address - Country:US
Practice Address - Phone:410-334-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3856225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant