Healthcare Provider Details

I. General information

NPI: 1306236831
Provider Name (Legal Business Name): MATTHEW FERGUSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 WILLWOOD DR
FLORENCE SC
29501-3904
US

IV. Provider business mailing address

2439 WILLWOOD DR
FLORENCE SC
29501-3904
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2250
  • Fax: 843-777-2250
Mailing address:
  • Phone: 843-777-2250
  • Fax: 843-777-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6241
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: