Provider Demographics
NPI:1306962204
Name:FAIRBANKS, ELIZABETH A (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
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 1:87 PUNKHORN POINT RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3874
Mailing Address - Country:US
Mailing Address - Phone:508-539-3157
Mailing Address - Fax:
Practice Address - Street 1:209 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2021
Practice Address - Country:US
Practice Address - Phone:508-563-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist