Provider Demographics
NPI:1457367377
Name:FERGUSON, CAROL D (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:FERGUSON
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 1:11307 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE 220
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3024
Mailing Address - Country:US
Mailing Address - Phone:253-985-2733
Mailing Address - Fax:253-985-2868
Practice Address - Street 1:11307 BRIDGEPORT WAY SW
Practice Address - Street 2:STE 220
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3024
Practice Address - Country:US
Practice Address - Phone:253-985-2733
Practice Address - Fax:253-985-2868
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8420549Medicaid
WA0195036OtherL & I
WA8904774OtherCRIME VICTIMS
WAQ41925Medicare UPIN
WA8420549Medicaid
WA8852832Medicare ID - Type Unspecified