Healthcare Provider Details

I. General information

NPI: 1043725278
Provider Name (Legal Business Name): RACHAEL FERGUSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 W KEMPER RD
CINCINNATI OH
45240-1619
US

IV. Provider business mailing address

1351 W KEMPER RD
CINCINNATI OH
45240-1619
US

V. Phone/Fax

Practice location:
  • Phone: 937-925-0835
  • Fax: 855-232-8604
Mailing address:
  • Phone: 937-925-0835
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA011347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: