Healthcare Provider Details

I. General information

NPI: 1619969748
Provider Name (Legal Business Name): MISTI L. FERGUSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 VALLEY VIEW DR
MOLINE IL
61265-6133
US

IV. Provider business mailing address

5250 COMPETITION DR STE 100
BETTENDORF IA
52722-8837
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-0866
  • Fax:
Mailing address:
  • Phone: 563-322-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013897
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03722
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: