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NPI Code Detail

MEDICARE: JILL MICHELLE BANKA PTA

MEDICARE: JILL MICHELLE BANKA PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1164642823
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL MICHELLE BANKA PTA
Provider Business Mailing Address
First Line : 13608 84TH AVE
Second Line :
City : COOPERSVILLE
State : MI
Zip : 49404-9730
Country : US
Telephone Number : 616-837-4504
Fax Number :
Provider Business Practice Location Address
First Line : 25 CONRAN DR
Second Line :
City : COOPERSVILLE
State : MI
Zip : 49404-1366
Country : US
Telephone Number : 616-997-6172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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Directions to “ JILL MICHELLE BANKA PTA” Practice Location

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