Active NPI
Tiffany Marshall Fairbanks, PT
- Physical Therapist
- Dallas, TX
National Provider Identifier
1013686187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1329850
- Practice address
- 10233 E Northwest Hwy Ste 410
Dallas, TX 75238-4430 - Phone
- (469) 221-9203
- NPI assigned
- Sep 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1329850 | TX | Primary |
Addresses
Primary practice location
10233 E Northwest Hwy Ste 410
Dallas, TX 75238-4430
Mailing address
9719 Shadydale LN
Dallas, TX 75238-4232
Phone (214) 557-2544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1329850 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vista Rehab Partners, LP | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1013686187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9719 SHADYDALE LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752384232",
"telephone_number": "214-557-2544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10233 E NORTHWEST HWY STE 410",
"city": "DALLAS",
"state": "TX",
"postal_code": "752384430",
"telephone_number": "469-221-9203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANKS",
"first_name": "TIFFANY",
"middle_name": "MARSHALL",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-10",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1329850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.