Provider Demographics
NPI:1326803289
Name:FAIRBANKS, TAYLOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 N 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3609
Mailing Address - Country:US
Mailing Address - Phone:480-273-9017
Mailing Address - Fax:
Practice Address - Street 1:9160 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6244
Practice Address - Country:US
Practice Address - Phone:480-767-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist