Provider Demographics
NPI:1053702019
Name:BANKS, GRANT ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:ALLEN
Last Name:BANKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 WOODRUFF RD STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3494
Mailing Address - Country:US
Mailing Address - Phone:864-513-3019
Mailing Address - Fax:864-712-9270
Practice Address - Street 1:355 WOODRUFF RD STE 203
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3494
Practice Address - Country:US
Practice Address - Phone:864-513-3019
Practice Address - Fax:864-712-9270
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7666225100000X
CA2945552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist