Provider Demographics
NPI:1528684420
Name:FERGUSON, REBECCA LEE (DPT)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BROADWAY ST APT B
Mailing Address - Street 2:
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-1303
Mailing Address - Country:US
Mailing Address - Phone:724-433-4674
Mailing Address - Fax:
Practice Address - Street 1:157 LEWIS ST
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7699
Practice Address - Country:US
Practice Address - Phone:907-488-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK159748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist