Provider Demographics
NPI:1285814848
Name:OGLESBY, JOHN PHILLIP (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILLIP
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6231
Mailing Address - Country:US
Mailing Address - Phone:954-850-9280
Mailing Address - Fax:954-524-0358
Practice Address - Street 1:1117 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6231
Practice Address - Country:US
Practice Address - Phone:954-850-9280
Practice Address - Fax:954-524-0358
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34585225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist