Provider Demographics
NPI:1275762684
Name:FERGUSON, JEREMIAH DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:DAVID
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 1:3800 WOODLAND PARK AVE N
Mailing Address - Street 2:STE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7926
Mailing Address - Country:US
Mailing Address - Phone:206-284-2396
Mailing Address - Fax:
Practice Address - Street 1:3800 WOODLAND PARK AVE N
Practice Address - Street 2:STE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7926
Practice Address - Country:US
Practice Address - Phone:206-284-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60093148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist