Provider Demographics
NPI:1437939451
Name:FERGUSON, AUSTIN BARTINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BARTINE
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 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:5959 BAKER RD STE 340
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5984
Practice Address - Country:US
Practice Address - Phone:651-348-7428
Practice Address - Fax:651-348-7432
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13625746-2401225100000X
MN13354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist