Provider Demographics
NPI:1659107209
Name:BANKS, MATTHEW CHRISTOPHER (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:BANKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GOLDEN EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-4412
Mailing Address - Country:US
Mailing Address - Phone:610-745-4427
Mailing Address - Fax:
Practice Address - Street 1:6300 GEORGETOWN BLVD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6481
Practice Address - Country:US
Practice Address - Phone:443-531-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD301452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic