Provider Demographics
NPI:1932137221
Name:FAIRLEY, DAVE MARELL (RKT)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:MARELL
Last Name:FAIRLEY
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
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Mailing Address - Street 1:1309 GREENBROOK BND
Mailing Address - Street 2:APT 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8696
Mailing Address - Country:US
Mailing Address - Phone:901-340-5498
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7459
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist