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General NPI Number Information
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NPI Number | 1326589557
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Entity Type | Individual
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Provider Name | COURTNEY FERGUSON PTA
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 2227 57TH ST SE
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City | AUBURN
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State | WA
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Zip | 98092-6521
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Country | US
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Telephone | 360-798-9897
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 57TH ST SE
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City | AUBURN
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State | WA
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Zip | 98092-6521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1 60263599
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License Number State | WA
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