Healthcare Provider Details

I. General information

NPI: 1295545200
Provider Name (Legal Business Name): KIERSTEN BANKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 DIABLO RD STE 110
DANVILLE CA
94526-3409
US

IV. Provider business mailing address

1468 GREENLAWN DR
DANVILLE CA
94526-5105
US

V. Phone/Fax

Practice location:
  • Phone: 925-855-8350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: