MEDICARE: LOGAN WOODALL

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	2305213619	VA

General Provider Information

NPI Number	:	1942821491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN WOODALL

Provider Business Mailing Address
First Line	:	20347 TIMBERLAKE RD STE B
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-7352
Country	:	US
Telephone Number	:	434-845-5641
Fax Number	:	434-509-1695

Provider Business Practice Location Address
First Line	:	118 OAKWOOD DR STE B
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-3001
Country	:	US
Telephone Number	:	434-845-5641
Fax Number	:	434-509-1695

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

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	06/11/2020

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Directions to “ LOGAN WOODALL ” Practice Location

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