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NPI Code Detail

MEDICARE: AMY LYNN FERGUSON P.T.

MEDICARE: AMY LYNN FERGUSON P.T.
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
1225100000XPhysical TherapistPT23086CA

General Provider Information

NPI Number : 1821071283
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN FERGUSON P.T.
Provider Business Mailing Address
First Line : 860 SOUTHAMPTON RD
Second Line :
City : BENICIA
State : CA
Zip : 94510-1907
Country : US
Telephone Number : 707-745-6144
Fax Number : 707-745-5698
Provider Business Practice Location Address
First Line : 127 HOSPITAL DR
Second Line : STE 101
City : VALLEJO
State : CA
Zip : 94589-2500
Country : US
Telephone Number : 707-552-8795
Fax Number : 707-552-9638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 01/03/2022

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