Provider Demographics
NPI:1689392631
Name:FAIRBANKS, KAYLEE FAYE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:FAYE
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:FAYE
Other - Last Name:HEDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4009 BELLAIRE BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1168
Mailing Address - Country:US
Mailing Address - Phone:281-208-9200
Mailing Address - Fax:281-208-9210
Practice Address - Street 1:5425 HIGHWAY 6 STE D900
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4384
Practice Address - Country:US
Practice Address - Phone:281-208-9200
Practice Address - Fax:281-208-9210
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist