Provider Demographics
NPI:1134333586
Name:BANKS, CHRISTINE LAURA (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LAURA
Last Name:BANKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LAURA
Other - Last Name:TREFZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3055 231ST LN SE
Mailing Address - Street 2:E-105
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-6298
Mailing Address - Country:US
Mailing Address - Phone:509-910-2548
Mailing Address - Fax:
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065
Practice Address - Country:US
Practice Address - Phone:509-910-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160041149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant