Healthcare Provider Details

I. General information

NPI: 1487030938
Provider Name (Legal Business Name): CHRISTINA FERGUSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 KANAWHA BLVD W STE 300
CHARLESTON WV
25302-2350
US

IV. Provider business mailing address

#L-3137
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-988-4371
  • Fax: 304-743-4954
Mailing address:
  • Phone: 304-733-9560
  • Fax: 304-733-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006687
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003519
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: