Provider Demographics
NPI:1811088891
Name:BANKSTON, JENNIFER ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9300 STOCKDALE HIGHWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-663-8483
Mailing Address - Fax:661-663-3095
Practice Address - Street 1:815 TUCKER RD STE C
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2513
Practice Address - Country:US
Practice Address - Phone:661-661-7975
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist