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General NPI Number Information
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NPI Number | 1578275871
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Entity Type | Individual
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Provider Name | SUSAN WHITTED IRBY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 314 S MULBERRY AVE
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City | BUTLER
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State | AL
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Zip | 36904-2528
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Country | US
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Telephone | 731-307-7531
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Fax |
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Provider Business Mailing Address
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Address Line | 6488B SHANNON RD
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City | MERIDIAN
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State | MS
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Zip | 39301-8594
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Country | US
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Telephone | 731-307-7531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH9004
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License Number State | AL
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