Basic Information
| Provider Information | |||||||||
| NPI: | 1891123212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKE | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 685 36TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035408701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 WILCO RD | ||||||||
| Address2: | |||||||||
| City: | STAYTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973831085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037697131 | ||||||||
| FaxNumber: | 5037697132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2013 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 60218 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.