Provider Demographics
NPI:1649678392
Name:OGLESBY, CHRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 NW 175TH DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4710
Mailing Address - Country:US
Mailing Address - Phone:305-308-0452
Mailing Address - Fax:
Practice Address - Street 1:780 NW 175TH DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4710
Practice Address - Country:US
Practice Address - Phone:305-308-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant