MEDICARE: LOGAN MOLZAHN DPT

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	14175	MN
2	225100000X	Physical Therapist	14954	WI
3	225100000X	Physical Therapist	62615	OR

General Provider Information

NPI Number	:	1972001261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN MOLZAHN DPT

Provider Business Mailing Address
First Line	:	400 E 3RD ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55805-1951
Country	:	US
Telephone Number	:	218-786-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 LUNDORFF DR
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5099
Country	:	US
Telephone Number	:	320-245-2211
Fax Number	:

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

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	11/30/2025

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