Individual
DONNA Y. FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNMT, LMT
Contact information
Practice address
550 E STRAWBRIDGE AVE STE B, MELBOURNE, FL 32901-4905
(321) 951-3232
(321) 951-8291
Mailing address
2669 VINING ST, MELBOURNE, FL 32904-7492
(321) 795-5735
(321) 951-8291
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MA 35010
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C1837
BLUE CROSS BLUE SHIELD
FL
01
—
MA 35010
STATE LICENSE
FL
Enumeration date
07/31/2006
Last updated
07/08/2007
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