Individual
JILL MICHELLE BANKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
25 CONRAN DR, COOPERSVILLE, MI 49404-1366
(616) 997-6172
Mailing address
13608 84TH AVE, COOPERSVILLE, MI 49404-9730
(616) 837-4504
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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