MEDICARE: RACHAEL FERGUSON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA011347	OH

General Provider Information

NPI Number	:	1043725278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL FERGUSON PTA

Provider Business Mailing Address
First Line	:	1351 W KEMPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1619
Country	:	US
Telephone Number	:	937-925-0835
Fax Number	:	855-232-8604

Provider Business Practice Location Address
First Line	:	1351 W KEMPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1619
Country	:	US
Telephone Number	:	937-925-0835
Fax Number	:	855-232-8604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	12/20/2019

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