Provider Demographics
NPI:1932733300
Name:FERGUSON, KARISTA MAE (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:KARISTA
Middle Name:MAE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 SUNRISE TRAIL PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8195
Mailing Address - Country:US
Mailing Address - Phone:304-593-1626
Mailing Address - Fax:
Practice Address - Street 1:7878 WADSWORTH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2121
Practice Address - Country:US
Practice Address - Phone:303-456-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018518225100000X
COPTL.0020892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist