Provider Demographics
NPI:1497953525
Name:OGDEN, AMY DIANE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:DIANE
Last Name:OGDEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2133
Mailing Address - Country:US
Mailing Address - Phone:314-522-8100
Mailing Address - Fax:314-524-3557
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:800-677-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000865225200000X
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant