Provider Demographics
NPI:1831745397
Name:IRBY, TAYLOR AMANDA (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:AMANDA
Last Name:IRBY
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 1:6688 JOHN HICKMAN PKWY APT 123
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9600
Mailing Address - Country:US
Mailing Address - Phone:601-826-3807
Mailing Address - Fax:972-378-1432
Practice Address - Street 1:204 ENTERPRISE DR UNIT 15
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2761
Practice Address - Country:US
Practice Address - Phone:662-234-0010
Practice Address - Fax:662-234-0017
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7027225100000X
TX1320449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist