Individual
CORY DAVID FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
250 N LITCHFIELD RD, STE. 155, GOODYEAR, AZ 85338-1333
(623) 882-9787
(623) 882-9791
Mailing address
250 N LITCHFIELD RD, STE. 155, GOODYEAR, AZ 85338-1333
(623) 882-9787
(623) 882-9791
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6122
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0142085
DEPT OF LABOR
AZ
01
—
103195
MEDICARE
AZ
01
—
2Z2985
HEALTHNET
AZ
01
—
6122
LICENSE #
AZ
01
—
64-0096
EVERCARE
AZ
01
—
7499498
AETNA
AZ
01
—
916190
AHCCCS
AZ
01
—
AZ0299850
BCBS
AZ
01
—
P00388070
RR MEDICARE
AZ
Enumeration date
09/12/2007
Last updated
09/12/2007
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