Healthcare Provider Details

I. General information

NPI: 1578286373
Provider Name (Legal Business Name): BRIAN FERGUSON ASSOCIATES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FOUNTAINGROVE PKWY
SANTA ROSA CA
95403-5720
US

IV. Provider business mailing address

9892 HAMLET CT S
COTTAGE GROVE MN
55016-4833
US

V. Phone/Fax

Practice location:
  • Phone: 707-566-8600
  • Fax:
Mailing address:
  • Phone: 612-876-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: