Provider Demographics
NPI:1417406067
Name:FERRIS, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:FERRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 CYPRESS TER STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8801
Mailing Address - Country:US
Mailing Address - Phone:239-321-0392
Mailing Address - Fax:
Practice Address - Street 1:7051 CYPRESS TER
Practice Address - Street 2:STE 108
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8822
Practice Address - Country:US
Practice Address - Phone:239-437-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO258222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist