Provider Demographics
NPI:1598961856
Name:FERGUSON, KIMBERLY H (MSPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
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:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24077-0358
Mailing Address - Country:US
Mailing Address - Phone:540-985-0500
Mailing Address - Fax:540-985-0529
Practice Address - Street 1:1015 1ST ST SW
Practice Address - Street 2:SUITE 2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4430
Practice Address - Country:US
Practice Address - Phone:540-985-0500
Practice Address - Fax:540-985-0529
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADB4209OtherRR MEDICARE
VADB4209OtherRR MEDICARE