MEDICARE: SUSAN WHITTED IRBY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH9004	AL

General Provider Information

NPI Number	:	1578275871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WHITTED IRBY PT, DPT

Provider Business Mailing Address
First Line	:	6488B SHANNON RD
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-8594
Country	:	US
Telephone Number	:	731-307-7531
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 S MULBERRY AVE
Second Line	:
City	:	BUTLER
State	:	AL
Zip	:	36904-2528
Country	:	US
Telephone Number	:	731-307-7531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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