Individual
MALLORY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 SAVANNAH ST, MOUND CITY, MO 64470-1539
(402) 301-9885
Mailing address
1401 SAVANNAH ST, MOUND CITY, MO 64470-1539
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
005225
IA
225100000X
Physical Therapist
Primary
2005005090
MO
225100000X
Physical Therapist
PT60868468
WA
Other
Enumeration date
09/18/2018
Last updated
11/08/2019
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