Provider Demographics
NPI:1831105121
Name:FERGUSON, DONNA Y (CNMT, LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:Y
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CNMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 VINING ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7492
Mailing Address - Country:US
Mailing Address - Phone:321-795-5735
Mailing Address - Fax:321-951-8291
Practice Address - Street 1:550 E STRAWBRIDGE AVE STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4905
Practice Address - Country:US
Practice Address - Phone:321-951-3232
Practice Address - Fax:321-951-8291
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 35010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 35010OtherSTATE LICENSE
FLC1837OtherBLUE CROSS BLUE SHIELD