Provider Demographics
NPI:1023858453
Name:FAIRBANK, BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FAIRBANK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5455
Mailing Address - Country:US
Mailing Address - Phone:620-271-0700
Mailing Address - Fax:620-271-0703
Practice Address - Street 1:101 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5455
Practice Address - Country:US
Practice Address - Phone:620-271-0700
Practice Address - Fax:620-271-0703
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist