Provider Demographics
NPI:1366715013
Name:RAGAN & FERGUSON PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:RAGAN & FERGUSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-474-9253
Mailing Address - Street 1:1255 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-6804
Mailing Address - Country:US
Mailing Address - Phone:909-474-9253
Mailing Address - Fax:909-474-9050
Practice Address - Street 1:1255 E HIGHLAND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-6804
Practice Address - Country:US
Practice Address - Phone:909-474-9253
Practice Address - Fax:909-474-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16695261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT166950Medicare UPIN