Provider Demographics
NPI:1992436521
Name:FERGUSON, GENALEE (LMT)
Entity type:Individual
Prefix:
First Name:GENALEE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44121 HARRY BYRD HWY STE 255
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5671
Mailing Address - Country:US
Mailing Address - Phone:571-276-5148
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2228
Practice Address - Country:US
Practice Address - Phone:571-276-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019010592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist