Individual
STACY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, AA
Contact information
Practice address
1100 W CLARK RD, CONNELL, WA 99326-9700
(509) 234-2021
(509) 234-9200
Mailing address
PO BOX 829, CONNELL, WA 99326-0829
(509) 234-2021
(509) 234-9200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P1 60040866
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P1 60040866
PHYSICAL THERAPY ASSISTANT
WA
Enumeration date
11/28/2005
Last updated
01/18/2013
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