Provider Demographics
NPI:1164821682
Name:FERGUSON, DAYTON (DPT)
Entity Type:Individual
Prefix:
First Name:DAYTON
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0747
Mailing Address - Country:US
Mailing Address - Phone:435-654-4525
Mailing Address - Fax:435-654-4138
Practice Address - Street 1:513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1214
Practice Address - Country:US
Practice Address - Phone:435-654-4525
Practice Address - Fax:435-654-4138
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9049002-2401172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker