Provider Demographics
NPI:1770063216
Name:BANKS, JENNIFER LEEANN (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEEANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 COUGAR DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8380
Mailing Address - Country:US
Mailing Address - Phone:406-599-1649
Mailing Address - Fax:
Practice Address - Street 1:64-974 MAMALAHOA HWY STE 103
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7334
Practice Address - Country:US
Practice Address - Phone:808-887-1371
Practice Address - Fax:808-887-1373
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT149142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic