Healthcare Provider Details

I. General information

NPI: 1346722352
Provider Name (Legal Business Name): LAUREN BANKS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W STOCKTON BLVD
ELK GROVE CA
95758-8073
US

IV. Provider business mailing address

773 TEAKWOOD LN
SAN DIMAS CA
91773-3634
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-2580
  • Fax:
Mailing address:
  • Phone: 925-216-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT295734
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: