Individual
CORY DAVID FERGUSON
Active
Individual
CORY DAVID FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
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
Update your record
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