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General NPI Number Information
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NPI Number | 1205254877
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Entity Type | Organization
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Legal Business Name | FERGUSON PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 2628 EL CAMINO AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-5934
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Country | US
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Telephone | 916-977-0267
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 BUTANO DR
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City | SACRAMENTO
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State | CA
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Zip | 95821-6402
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Country | US
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Telephone | 916-977-0267
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KRISTIN FERGUSON
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Credential | PT, CLT
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Telephone | 916-977-0267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 24972
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License Number State | CA
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