Provider Demographics
NPI:1265587638
Name:FERGUSON, SHAYNE KIRK (PT)
Entity type:Individual
Prefix:MR
First Name:SHAYNE
Middle Name:KIRK
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1321 RING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8940
Mailing Address - Country:US
Mailing Address - Phone:270-986-7432
Mailing Address - Fax:270-986-7201
Practice Address - Street 1:1321 RING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8940
Practice Address - Country:US
Practice Address - Phone:270-986-7432
Practice Address - Fax:270-986-7201
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK228260Medicare PIN