Individual
LARRY ALLEN BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRPS, CAC
Contact information
Practice address
7114 79TH TER N # 139, PINELLAS PARK, FL 33781-1918
(727) 421-2070
Mailing address
7114 79TH TER N # 139, PINELLAS PARK, FL 33781-1918
(727) 421-2070
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CRPS.0100840.A
FL
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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