Provider Demographics
NPI:1366946543
Name:FERGUSON, ANGELA DIANE (MS PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DIANE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALBA DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9678
Mailing Address - Country:US
Mailing Address - Phone:304-586-2444
Mailing Address - Fax:
Practice Address - Street 1:1000 ASSOCIATION DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1270
Practice Address - Country:US
Practice Address - Phone:304-347-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist