MEDICARE: MEDICAL LOGIC FT. WALTON, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BX2000X	Oxygen Equipment & Supplies (DME)	326880	FL

General Provider Information

NPI Number	:	1891055885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL LOGIC FT. WALTON, INC.

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 MAR WALT DR STE 101
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6703
Country	:	US
Telephone Number	:	850-862-6277
Fax Number	:	850-862-6279

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	10/15/2025

Similar Medicare Providers

1326546482 — MRS. ALINA GRIFFITH LMHC
Practice Location Address:

922 MAR WALT DR STE 200
FORT WALTON BEACH, FL
32547-6703

Practice Phone: 850-517-4604
Practice Fax: 850-204-9330

1679363865 — KIZUNA COUNSELING LLC
Practice Location Address:

922 MAR WALT DR STE 200
FORT WALTON BEACH, FL
32547-6703

Practice Phone: 850-517-6703
Practice Fax: 850-204-9330

1992767313 — CHUONG VAN PHAM D.C.
Practice Location Address:

1916 N BEACH ST
HALTOM CITY, TX
76111-6703

Practice Phone: 817-759-2777
Practice Fax: 817-759-2779

1003951021 — DR. ALWYN ANTHONY LORENZO D.C.
Practice Location Address:

1916 N BEACH ST
HALTOM CITY, TX
76111-6703

Practice Phone: 817-222-0697
Practice Fax: 817-222-0699

1427376433 — M.A.N. CHIROPRACTIC, PC
Practice Location Address:

1916 N BEACH ST
HALTOM CITY, TX
76111-6703

Practice Phone: 817-222-0697
Practice Fax: 817-222-0699

1639422421 — BARBARA LEE REITZ L.C.S.W.
Practice Location Address:

2268 NE GINGER TER
JENSEN BEACH, FL
34957-6703

Practice Phone: 772-486-3718
Practice Fax:

Directions to “MEDICAL LOGIC FT. WALTON, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.