Provider Demographics
NPI:1124320130
Name:VOGT, MICHAEL KENNETH (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNETH
Last Name:VOGT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18942 DALE MABRY HWY N
Mailing Address - Street 2:STE 102
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4907
Mailing Address - Country:US
Mailing Address - Phone:813-909-0961
Mailing Address - Fax:813-909-2086
Practice Address - Street 1:18942 DALE MABRY HWY N
Practice Address - Street 2:STE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4907
Practice Address - Country:US
Practice Address - Phone:813-909-0961
Practice Address - Fax:813-909-2086
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA46946225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA46946OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH