Healthcare Provider Details

I. General information

NPI: 1215551734
Provider Name (Legal Business Name): KUMIKO BANKSON PT, DPT, OCS, CMPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ROBERTSON BLVD STE 101
BEVERLY HILLS CA
90211-1729
US

IV. Provider business mailing address

201 N ROBERTSON BLVD STE 101
BEVERLY HILLS CA
90211-1729
US

V. Phone/Fax

Practice location:
  • Phone: 424-303-7647
  • Fax: 424-303-7648
Mailing address:
  • Phone: 424-303-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number307300
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3125253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: