Healthcare Provider Details

I. General information

NPI: 1598911927
Provider Name (Legal Business Name): DIANE S FERGUSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7645 MARKET ST STE 110
YOUNGSTOWN OH
44512-6098
US

IV. Provider business mailing address

PO BOX 392573
PITTSBURGH PA
15251-9500
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9330
  • Fax:
Mailing address:
  • Phone: 724-343-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: