Provider Demographics
NPI:1639118763
Name:FERGUSON, JAMES W (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1335
Mailing Address - Country:US
Mailing Address - Phone:740-592-6900
Mailing Address - Fax:740-593-3530
Practice Address - Street 1:215 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1335
Practice Address - Country:US
Practice Address - Phone:740-592-6900
Practice Address - Fax:740-593-3530
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9300111Medicare PIN
OHFE0862201Medicare PIN
OHS68005Medicare UPIN