Provider Demographics
NPI:1982972428
Name:BANKS, GEORGIA B (CMT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:B
Last Name:BANKS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 OLD TUNNEL RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4198
Mailing Address - Country:US
Mailing Address - Phone:925-586-3951
Mailing Address - Fax:
Practice Address - Street 1:3190 OLD TUNNEL RD STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4198
Practice Address - Country:US
Practice Address - Phone:925-586-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24846225700000X
IN20901809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist