Provider Demographics
NPI:1578728911
Name:FERGUSON, JENNIFER L (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7698
Mailing Address - Country:US
Mailing Address - Phone:770-513-0839
Mailing Address - Fax:770-513-7850
Practice Address - Street 1:601 PROFESSIONAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7698
Practice Address - Country:US
Practice Address - Phone:770-513-0839
Practice Address - Fax:770-513-7850
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist