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NPI Code Detail

MEDICARE: STEPHANIE JANE FERGUSON PTA

MEDICARE:   STEPHANIE JANE FERGUSON  PTA
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
1225200000XPhysical Therapy AssistantA02317KY

General Provider Information

NPI Number : 1629313549
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JANE FERGUSON PTA
Provider Business Mailing Address
First Line : 795 NOAH BLEDSOE RD
Second Line :
City : SMITHS GROVE
State : KY
Zip : 42171-8275
Country : US
Telephone Number : 270-597-9759
Fax Number :
Provider Business Practice Location Address
First Line : 813 S MAIN ST
Second Line :
City : BROWNSVILLE
State : KY
Zip : 42210-9009
Country : US
Telephone Number : 270-597-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2012
Last Update Date : 12/04/2012

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Directions to “ STEPHANIE JANE FERGUSON PTA” Practice Location

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