Healthcare Provider Details

I. General information

NPI: 1710235874
Provider Name (Legal Business Name): LAUREN A FERGUSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15476B DEDEAUX RD
GULFPORT MS
39503-2637
US

IV. Provider business mailing address

900 HOLCOMB BLVD STE A
OCEAN SPRINGS MS
39564-3903
US

V. Phone/Fax

Practice location:
  • Phone: 228-539-3232
  • Fax: 228-539-3230
Mailing address:
  • Phone: 228-388-5714
  • Fax: 228-388-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5113
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: