Provider Demographics
NPI:1417372822
Name:FERGUSON, AMANDA SUE (MSPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 10TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-9628
Mailing Address - Country:US
Mailing Address - Phone:330-383-5357
Mailing Address - Fax:
Practice Address - Street 1:425 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2405
Practice Address - Country:US
Practice Address - Phone:330-386-2054
Practice Address - Fax:330-386-2679
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH10247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist