MEDICARE: LOGAN REED

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1922781954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN REED

Provider Business Mailing Address
First Line	:	3 WOODSONG DR
Second Line	:
City	:	ROLAND
State	:	AR
Zip	:	72135-9044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 BAINBRIDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2811
Country	:	US
Telephone Number	:	945-231-2647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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Directions to “ LOGAN REED ” Practice Location

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