Provider Demographics
NPI:1013686187
Name:FAIRBANKS, TIFFANY MARSHALL (PT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MARSHALL
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9719 SHADYDALE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4232
Mailing Address - Country:US
Mailing Address - Phone:214-557-2544
Mailing Address - Fax:
Practice Address - Street 1:10233 E NORTHWEST HWY STE 410
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4430
Practice Address - Country:US
Practice Address - Phone:469-221-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1329850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist