Healthcare Provider Details

I. General information

NPI: 1043222821
Provider Name (Legal Business Name): RICHARD J. OGDEN MS, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 NW 41ST ST SUITE D
GAINESVILLE FL
32606-7499
US

IV. Provider business mailing address

3919 SW 21ST ST SUITE D
GAINESVILLE FL
32608-3317
US

V. Phone/Fax

Practice location:
  • Phone: 352-538-4603
  • Fax: 352-335-3939
Mailing address:
  • Phone: 352-538-4603
  • Fax: 352-335-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA44043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: