Provider Demographics
NPI:1447549712
Name:VOGT, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:VOGT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N L ST
Mailing Address - Street 2:#2
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3479
Mailing Address - Country:US
Mailing Address - Phone:517-914-0736
Mailing Address - Fax:
Practice Address - Street 1:122 N L ST
Practice Address - Street 2:#2
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3479
Practice Address - Country:US
Practice Address - Phone:517-914-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist