Alyssa B Fairbanks, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06005941A Issued in IN

Practice address

3110 Mallard Cove LN
Fort Wayne, IN 46804-2882

Phone

(260) 431-8198

Fax

(260) 755-0475

NPI assigned

Nov 23, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Tippmann Physical Therapy, LLC

  • Orthopedic Physical Therapist
  • Fort Wayne, IN
  • NPI 1831740117
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1508523697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042882",
            "telephone_number": "260-431-8198",
            "fax_number": "260-755-0475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042882",
            "telephone_number": "260-431-8198",
            "fax_number": "260-755-0475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "ALYSSA",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-23",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06005941A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fab Mental Health Counseling LLC
• Jessica Fabian
• Jean M Fabini, NP
• Ellen Catherine Fagan-Pryor, MSN, PMHCNS, RN
• Benny Fair Jr., D.P.M.
• Joshua Fairbanks
• Shah Faisal
• John M Falatko
• Stephanie R Falatko, D.O.
• Ali E Falcone, LSW

• Physical Therapy Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.

Verify at the official NPI Registry.