Healthcare Provider Details

I. General information

NPI: 1760065056
Provider Name (Legal Business Name): GERALD RAY OGDEN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 27TH ST W
UNIVERSITY PLACE WA
98466
US

IV. Provider business mailing address

7105 27TH ST W
UNIVERSITY PLACE WA
98466
US

V. Phone/Fax

Practice location:
  • Phone: 253-330-9461
  • Fax: 253-503-7570
Mailing address:
  • Phone: 253-330-9461
  • Fax: 253-503-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: