Individual
MARY-ROSELLEN BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 467-1900
(757) 467-7900
Mailing address
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 467-1900
(757) 467-7900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305204353
VA
2255A2300X
Athletic Trainer
0126000598
VA
Other
Enumeration date
09/02/2014
Last updated
03/01/2017
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