Provider Demographics
NPI:1861762304
Name:FERGUSON, GEORGIA RAYNE (LMP)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:RAYNE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 ROOSEVELT WAY NE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3697
Mailing Address - Country:US
Mailing Address - Phone:206-547-4427
Mailing Address - Fax:206-547-3587
Practice Address - Street 1:5029 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 101A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3697
Practice Address - Country:US
Practice Address - Phone:206-547-4427
Practice Address - Fax:206-547-3587
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60089157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist