Provider Demographics
NPI:1629192257
Name:FERNEYHOUGH, JOHN M (MPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:FERNEYHOUGH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 SAVANNAH BAY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9560
Mailing Address - Country:US
Mailing Address - Phone:423-718-5995
Mailing Address - Fax:
Practice Address - Street 1:5572 LITTLE DEBBIE PKWY
Practice Address - Street 2:SUITE 122
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4364
Practice Address - Country:US
Practice Address - Phone:423-238-4141
Practice Address - Fax:423-238-4142
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist