Provider Demographics
NPI:1447875745
Name:FERGUSON, SEAN KEVIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:KEVIN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NOVACARE REHABILITATION 30655 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-574-1200
Mailing Address - Fax:586-574-9425
Practice Address - Street 1:30655 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6537
Practice Address - Country:US
Practice Address - Phone:586-574-1200
Practice Address - Fax:586-574-9425
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302116208100000X
CAPT298262208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT298262OtherLICENSE
MI5501302116OtherLICENSE