Healthcare Provider Details

I. General information

NPI: 1811088891
Provider Name (Legal Business Name): JENNIFER ANNE BANKSTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN SMITH PT

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TUCKER RD STE C
TEHACHAPI CA
93561-2513
US

IV. Provider business mailing address

9300 STOCKDALE HIGHWAY SUITE 400
BAKERSFIELD CA
93311
US

V. Phone/Fax

Practice location:
  • Phone: 661-661-7975
  • Fax: 661-616-9199
Mailing address:
  • Phone: 661-663-8483
  • Fax: 661-663-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21084
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: