Provider Demographics
NPI:1588367767
Name:FERGUSONHARDIN, YVONNE D (BS, MFS,GFI)
Entity type:Individual
Prefix:MISS
First Name:YVONNE
Middle Name:D
Last Name:FERGUSONHARDIN
Suffix:
Gender:F
Credentials:BS, MFS,GFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W HORTTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2706
Mailing Address - Country:US
Mailing Address - Phone:973-922-3794
Mailing Address - Fax:
Practice Address - Street 1:47 E HIGH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19144-2116
Practice Address - Country:US
Practice Address - Phone:973-922-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty