Provider Demographics
NPI:1447656137
Name:FURGESON, JOHN MICHAEL (LMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FURGESON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2610
Mailing Address - Country:US
Mailing Address - Phone:816-682-5819
Mailing Address - Fax:855-682-5819
Practice Address - Street 1:810 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1908
Practice Address - Country:US
Practice Address - Phone:816-682-5819
Practice Address - Fax:855-682-5819
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010039289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist