Healthcare Provider Details

I. General information

NPI: 1669643904
Provider Name (Legal Business Name): DEBRA OGDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BRADEN RUN
BRADENTON FL
34202-9402
US

IV. Provider business mailing address

5801 BRADEN RUN
BRADENTON FL
34202-9402
US

V. Phone/Fax

Practice location:
  • Phone: 941-727-1500
  • Fax:
Mailing address:
  • Phone: 941-727-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: