Provider Demographics
NPI:1497227961
Name:FERGUSON, MICHAEL MANLEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MANLEY
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 1:5820 SOUTHHALL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1006
Mailing Address - Country:US
Mailing Address - Phone:205-310-6777
Mailing Address - Fax:
Practice Address - Street 1:5820 SOUTHHALL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1006
Practice Address - Country:US
Practice Address - Phone:205-310-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-0969225100000X
225100000X
ALPTH9312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497227961OtherNPI