Provider Demographics
NPI:1194123174
Name:FERGUSON, LINDSAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11361 S FOOTHILLS BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7743
Mailing Address - Country:US
Mailing Address - Phone:928-342-7234
Mailing Address - Fax:928-342-7235
Practice Address - Street 1:2105 MANOR DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1324
Practice Address - Country:US
Practice Address - Phone:765-891-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31124225100000X
IN05011176A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty