Provider Demographics
NPI:1528465572
Name:FERGUSON, THOMAS (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 HIBISCUS ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3077
Mailing Address - Country:US
Mailing Address - Phone:904-315-6037
Mailing Address - Fax:
Practice Address - Street 1:1336 HIBISCUS ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3077
Practice Address - Country:US
Practice Address - Phone:904-315-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL38222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer