Healthcare Provider Details

I. General information

NPI: 1881704955
Provider Name (Legal Business Name): LORA MICHELLE FERGUSON ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N WASHINGTON AVE
DALLAS TX
75246-1520
US

IV. Provider business mailing address

305 BROOKVIEW DR
GARLAND TX
75043-2902
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-9300
  • Fax:
Mailing address:
  • Phone: 575-268-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: