Provider Demographics
NPI:1760909782
Name:FERGUS, LESLIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:FERGUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 E HOBCAW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2550
Mailing Address - Country:US
Mailing Address - Phone:678-642-5497
Mailing Address - Fax:
Practice Address - Street 1:664 E HOBCAW DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2550
Practice Address - Country:US
Practice Address - Phone:678-642-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist