Provider Demographics
NPI:1043725278
Name:FERGUSON, RACHAEL (PTA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1619
Mailing Address - Country:US
Mailing Address - Phone:937-925-0835
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:1351 W KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1619
Practice Address - Country:US
Practice Address - Phone:937-925-0835
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant