Provider Demographics
NPI:1518376110
Name:FERGUSON, RICHARD (LMP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16720 116TH AVE SE
Mailing Address - Street 2:STE. 2
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16720 116TH AVE SE
Practice Address - Street 2:STE. 2
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-5277
Practice Address - Country:US
Practice Address - Phone:206-816-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60191886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60191886OtherWA SATE DEPARTMENT OF HEALTH MASSAGE PRACTITIONER LICENSE