Provider Demographics
NPI:1700063385
Name:FERGUSON, KRISTEN THAYER (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:THAYER
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:MCCALL
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1076 RIBAUT RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5476
Mailing Address - Country:US
Mailing Address - Phone:843-521-1970
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD
Practice Address - Street 2:STE 102
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5476
Practice Address - Country:US
Practice Address - Phone:843-521-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8972255A2300X
SC5662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer