Healthcare Provider Details

I. General information

NPI: 1063695179
Provider Name (Legal Business Name): DAMON J BANKS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRANS W VANDERBANK PT

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S RAPIDS RD
MANITOWOC WI
54220-4146
US

IV. Provider business mailing address

920 S RAPIDS ROAD
MANITOWOC WI
54220
US

V. Phone/Fax

Practice location:
  • Phone: 920-684-1144
  • Fax:
Mailing address:
  • Phone: 920-684-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4960024
License Number StateWI

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: