Provider Demographics
NPI:1487225546
Name:FERGUSON, KENDRA (PTA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 NE ALICES RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8857
Mailing Address - Country:US
Mailing Address - Phone:515-875-9706
Mailing Address - Fax:515-875-9611
Practice Address - Street 1:842 NE ALICES RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8857
Practice Address - Country:US
Practice Address - Phone:515-875-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant