Provider Demographics
NPI:1891755740
Name:FAIRBOURN, DAVID M (RPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:FAIRBOURN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13402 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE B150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4054
Mailing Address - Country:US
Mailing Address - Phone:480-951-1248
Mailing Address - Fax:
Practice Address - Street 1:13402 N SCOTTSDALE RD
Practice Address - Street 2:SUITE B150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4054
Practice Address - Country:US
Practice Address - Phone:480-951-1248
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR60739Medicare UPIN